Ever sneezed so hard it felt like some of your insides were about to come out with it? Well, that was more than just a feeling for one unlucky Florida man.
The 63-year-old was eating breakfast with his wife at a diner when he suddenly forcefully sneezed and then began to cough, according to a report in the American Journal of Medical Case Reports. After noticing a “wet” sensation and lower abdomen pain, he looked down to find “several loops” of his pink intestines protruding from a recent surgical wound outside of his body.
But don’t worry; this isn’t a regular occurrence for just anyone with a stomach laceration. The case report states evisceration is a rare complication of abdominal surgery, which the man underwent 15 days before the incident.
In his case, a history of prostate cancer and recent radiation therapy led him to undergo a cystectomy, a procedure to remove his urinary bladder. He was discharged home in good condition after the successful surgery and returned to the urology clinic the morning of his powerful sneeze. Doctors then removed the overlying staples from his wound, which “appeared well-healed,” and he and his wife went to the diner to celebrate.
The report in the medical journal states patients experiencing evisceration “may be unsure how to protect their exposed intestines,” and it’s safe to say this man is included in that group. When he later recounted the incident, per the report, the man said his uncertainty prompted him to cover his bowel with his shirt so he could drive himself to the hospital, but his wife called an ambulance over concerns that moving him would injure his bowel.
Upon arrival four minutes later, the paramedic also recounted being uncertain how to proceed because her medical protocols didn’t contain evisceration treatment guidelines. Her initial thought was to put the “large amounts of bowel” back inside the man’s body through his 3-inch laceration, which was minimally bleeding, but she decided against it over concerns it would further injure his intestine.
Instead, the paramedic covered the exposed bowel with a saline-moistened abdominal pad — a step she remembered from watching lectures about keeping penetrating trauma moist — and wrapped a gauze roll around his abdomen to secure it before administering pain medication.
The man arrived at the hospital with vital signs “within normal limits,” and in the operating room, three surgeons inspected the full length of the bowel to find no injury before they “carefully reduced” it back into the abdominal cavity. They closed the wound “with a variety of sutures.”
Six days later, the man was discharged in good condition after a “reassuring abdominal examination.”
The case report states wound dehiscence — the reopening of a surgical incision — is a well-described complication of open cystectomy, but the procedure has rarely resulted in evisceration through the abdominal wall, with only seven known cases.
Analysis of cystectomy cases in 2023 showed 6.9% reported a post-operative wound dehiscence in some form, and other research states two predictors of this were a high body mass index and chronic obstructive pulmonary disease — neither of which the man in this case had. However, the latter was thought to be a predictor because it can cause coughing, therefore inducing wound dehiscence through increased abdominal pressure. For that reason, the case report states the post-sneeze coughing may have caused the man’s evisceration.
