Written by Physician’s Weekly blogger, Skeptical Scalpel

 

I Can’t Stomach This One

Figure 1. Contrast in the stomach, showing an inguinal/scrotal hernia

An elderly man with a long history of a left inguinal hernia had several months of upper abdominal pain, difficulty swallowing, and weight loss. He had a large incarcerated left scrotal hernia. Imaging studies revealed a significant portion of the stomach was contained in the hernia sac. See figure 1.

The surgery consisted of laparoscopic reduction of the hernia with gastropexy to prevent it from dropping down into the pelvis again and an open mesh hernia repair. The patient recovered satisfactorily and his symptoms and weight loss resolved. The case was reported in the journal Surgery.

Things You Don’t See in Tonsils Every Day

Fig. 2 stone on Q-tip

Science blogger Paul Ingraham wrote about having a chronic painful sore throat. He described it as feeling like something was stuck in his throat. It was accompanied by spasms and painful swallowing. After suffering for many months, the pain became more intense. He tried irrigating his throat with saltwater and was rewarded with a stone popping out onto his tongue. See figure 2.

Fig 3. Stone in left tonsil

Over time, most of his symptoms completely resolved but he still had some unpleasant sensations which finally disappeared after 3 years. Here is what a tonsillith looks like in situ. See figure 3.

According to a case report in The American Journal of Tropical Medicine and Hygiene, a 25-year-old Japanese woman had an unpleasant sensation in the back of her throat 5 days after eating sashimi. On examination, a 38 mm, live black worm was seen in her left tonsil and removed with tweezers. If that isn’t disgusting enough, the worm was in the process of molting. See figure 4.

Figure 4. A molting worm.

It proved to be “a fourth-stage larva of Pseudoterranova azarasi.” The patient had ingested a third-stage larva at the time of the meal. The incidence of parasite infections is increasing because more people are eating raw fish.

 

Wire Ahead If You Can Make It

Figure 5. Wire exiting skull.

The Indian Journal of Critical Care Medicine featured an article about a hemodialysis catheter guidewire that spontaneously perforated the skull of a 75-year-old man who noticed it while combing his hair. He was asymptomatic. A CT scan of his head showed the guidewire coming out of the right internal jugular vein and going through his brain before penetrating the right parietal skull. See figures 5 and 6.

Figure 6. CT scan showing wire.

He underwent emergency surgery to remove most of the wire. Several small fragments of the wire could be seen in the brain on a postoperative CT scan. The patient did well after the surgery.

The case reminds me of my 2017 blog post about a nasogastric tube that went through the pharyngeal wall into the right internal jugular vein. The outcome was not as positive as the guidewire case above.

 

Skeptical Scalpel is a retired surgeon and was a surgical department chair and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times.For the last 9 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.

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