Florida man’s bowels explode out of surgical incision after sneezing

By Stephanie Srakocic | Fact-checked by Davi Sherman
Published June 14, 2024

Key Takeaways

  • A man experienced a rare post-surgical complication when his bowel erupted through a healing surgical incision.

  • He recovered well after emergency surgery and a 6-day hospital stay. 

  • Currently, there are no EMS guidelines for managing abdominal evisceration, but paramedics can follow those published by Tactical Combat Casualty Care, which include control visible bleeding, rinse the bowel with sterile saline or water, cover the exposed bowel, and irrigate the dressings as needed.

A 63-year-old man went out for breakfast with his wife at a Florida diner to celebrate having his surgical staples removed. However, when he sneezed during his meal, he felt a “wet” sensation and pain in his lower abdomen.

Upon lifting his shirt, the man discovered that several inches of his bowel had erupted through his healing surgical incision.[]

Post-surgical complication

The incision had been created 15 days earlier during a procedure for treating prostate cancer. The cancer was first diagnosed and treated 9 years earlier with a robotic-assisted laparoscopic prostatectomy. The man was then diagnosed with recurrent prostate cancer after a persistent elevation of prostate-specific antigen was noted. Prior to his second surgery—an open cystectomy with  bilateral uretero-ileal conduit diversion—he received several months of salvage radiation therapy. 

There were no observed complications during the surgery. During a morning follow-up appointment, his wound was observed to be well-healed, and his staples were removed. 

Back to the hospital

After the bowel eruption, emergency medical services were dispatched to the Florida diner. Paramedics noted the man’s shirt was soaked with fluids. They measured an approximately 3-inch-long laceration with “large amounts of bowel” protruding out of it. According to paramedics’ records, bleeding was minimal. 

The paramedic on the scene reportedly did not have specific guidelines for treating evisceration. She briefly considered using a sterile technique to guide the man’s bowel back through the laceration, but was concerned that this might worsen the injury. Instead, she covered the exposed bowel with a saline-moistened abdominal pad and then wrapped the man’s entire abdomen in gauze to secure the laceration. She also administered IV fentanyl and ondansetron.

The man spent the next 6 days in the hospital. He was treated with IV analgesics for pain, and his wound was managed through a vacuum and tube. Before being discharged, the tubes and vacuum were removed, and the man was able to tolerate a normal diet. He was discharged in good condition. 

A lack of established protocol

The man’s final diagnosis was evisceration. There have been seven other cases related to evisceration through the abdominal wall after cystectomy.

A detailed report of this unusual case was presented to the American Journal of Medical Case Reports.[]

Discussing the rarity of this presentation, the authors wrote:

“In this case, the responding paramedic did not have a protocol for treating evisceration. Emergency Medical Services medical directors might consider incorporating the guidelines for abdominal evisceration published by Tactical Combat Casualty Care, including: control visible bleeding, address gross contamination by rinsing the bowel with sterile saline or sterile water, cover the exposed bowel with a ‘moist, sterile dressing or a sterile water-impermeable covering,’ and irrigate these dressings as needed with additional sterile fluid.” 

Evisceration as a surgical complication

Wound dehiscence is a well-understood and well-known complication of surgery. In one study, the rate of wound dehiscence following open cystectomy was as high as 6.9%.[] Factors such as obesity and COPD have been found to increase the risk of dehiscence. 

Evisceration, however, is significantly less common. This rare complication is a medical emergency that occurs in about 0.5% to 1.2% of all abdominal surgeries.[] About 20% to 40% of wound dehiscence develops into evisceration. 

Interestingly, unlike many medical complications, rates of post-surgical evisceration haven’t changed in the past hundred years. This is thought to be due to factors such as the increasing complexity of surgical procedures. 

“We see that it’s caused by abdominal wall tension overpowering either fascial strength, suture strength, or knot security,” Texas surgeon Patrick Wallas, MD, tells MDLinx. “Often, you’ll find that sutures are intact but that they’ve been pulled through the fascia due to fascial necrosis. This happens most commonly in longer incisions with increased pressure. It can happen to wounds of any size, but it’s most often wounds of 18 centimeters or above.” 

Like wound dehiscence, obesity can increase the risk of evisceration.[] Other risk factors include diabetes, malnutrition, and wound infection. 

“The risk factors are the same as the risk factors for any type of poor wound healing, but there is also the additional risk factor of postoperative ascites,” says Dr. Wallas. “This increases distension, and that increases tension on the wound and the risk of dehiscence and evisceration.”

What this means for you

It’s well-known that surgical complications can sometimes turn into medical emergencies. Some, such as infections or poor reactions to anesthesia, are commonly discussed, but others, such as evisceration, are rare. 

Read Next: Could this be the key to successfully using pig organs?
Share with emailShare to FacebookShare to LinkedInShare to Twitter