Doctors do rare surgery to remove 16 cms long knife from man's liver which he had swallowed two months ago
Doctors do rare surgery to remove 16 cms long knife from man's liver which he had swallowed two months ago
Sagaya FernandoMumbai: 29 July 2020
Through a rare and a challenging surgery, doctors in India were able to save a 28-year-old man who had swallowed a 16 centimetres long knife nearly two months ago.
The man had some psychological issues. A daily wage earner, he was at home in a small town in the outskirts of New Delhi, following the COVID-19 lock down doing nothing.
"Nearly 2 months ago, unknown to anyone at home, he swallowed a kitchen knife gulping it down with water. After a month and half developed, he developed pain in the abdomen along with fever and mild vomiting," said Dr Nihar Ranjan Dash, Professor - Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), New Delhi, who conducted the surgery along with his team.
He added, "The patient was initially taken to Safdarjung Hospital, in New Delhi itself, where an X-ray showed a knife blade lodged in the liver. He was brought to our hospital in a critical condition on July 12."
"The CT scan showed the blade of the knife in the liver and the handle in duodenum. This had caused a liver abscess, severe anemia and sepsis. A COVID-19 test was done to rule out corona virus infection," said Dr Dash.
"First, to optimize the patient's condition for surgery, the liver abscess and the effusion were drained by the radiologist. With antibiotics, IV nutrition and transfusion, his sepsis improved but became static," said he.
"Saw type edges can cut while pulling thereby damaging the internal organs leading to chance of uncontrollable bleeding, and chance for further sepsis. As it was very risky for removal of the knife by endoscopy for possible bleeding, liver tear, and bowel tear, so this procedure was not carried out," said Dr Dash.
He pointed out that the 16 centimetres long knife was just millimetres away from big blood vessels in the liver and bile ducts.
"The radiologist first put tubes to take out the liver pus 100 ml a day. Tube to take out water from the chest. Gave blood transfusion and nutrition through blood called TPN and continuous psychiatrist counselling," informed Dr Dash.
"On July 19 we operated on him with all arrangements of possible inoperative problems of severe bleeding and need to cut the liver if required and the endoscopy on table. We took out the knife through a hole in the duodenum, ensured hemostasis, closed it and put a tube for feeding during the healing period," said Dr Dash.
The surgery lasted nearly three hours. Dr Dash was assisted by Gastrointestinal Surgery - Head of Department Dr Peush Sahni, Anaesthesiology, Pain Medicine and Critical Care - HoD Prof. (Dr) Rajeshwari Subramanium and her team, Gastroenterology HoD Prof. (Dr) Anoop Saraya and team, Radiology HoD Prof. Arun Kumar Gupta and team, and Psychiatry HoD Prof. (Dr) R K Chadda and his team.
The psychiatrists were constantly taking care of the patient from the date of admission on July 12 till day before surgery and after to avoid further reaction from the patient.
"There have been reports of small needles and fish bone going into the liver after perforating the duodenum. But such a big sharp knife ingestion has not been reported. We are searching for more medical literature in this regard," informed Dr Dash.
"The knife could have easily perforated the esophagus and gone into the trachea, heart or big vessels, on its journey from mouth to liver via duodenum," said he.
"The operation was not difficult by our standard. But we were ready for any eventuality like torrential bleeding from liver or cutting through liver to retrieve it and check bleeding or bile leak," said Dr Dash, adding that team effort of emergency, psychiatry, anaesthesia, covid test team, radiology, gastromedicine and surgery helped in proper management.
"Covid testing was done on the patient twice first on admission, and the second one day before surgery. Both were negative. Even though two tests were done, operating in Covid era, there remains 30 per cent risk to the surgeon and the patient," said he.
"Post-surgery, he is recovering well. The pus and chest tubes have been taken out and now he is able to eat food by mouth. He is also able to walk around, We are also watching for any delayed complications if at all occurs," informed Dr Dash, adding that the patient will be discharged soon.
Sagaya FernandoMumbai: 29 July 2020
The man had some psychological issues. A daily wage earner, he was at home in a small town in the outskirts of New Delhi, following the COVID-19 lock down doing nothing.
"Nearly 2 months ago, unknown to anyone at home, he swallowed a kitchen knife gulping it down with water. After a month and half developed, he developed pain in the abdomen along with fever and mild vomiting," said Dr Nihar Ranjan Dash, Professor - Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), New Delhi, who conducted the surgery along with his team.
He added, "The patient was initially taken to Safdarjung Hospital, in New Delhi itself, where an X-ray showed a knife blade lodged in the liver. He was brought to our hospital in a critical condition on July 12."
"The CT scan showed the blade of the knife in the liver and the handle in duodenum. This had caused a liver abscess, severe anemia and sepsis. A COVID-19 test was done to rule out corona virus infection," said Dr Dash.
"First, to optimize the patient's condition for surgery, the liver abscess and the effusion were drained by the radiologist. With antibiotics, IV nutrition and transfusion, his sepsis improved but became static," said he.
"Saw type edges can cut while pulling thereby damaging the internal organs leading to chance of uncontrollable bleeding, and chance for further sepsis. As it was very risky for removal of the knife by endoscopy for possible bleeding, liver tear, and bowel tear, so this procedure was not carried out," said Dr Dash.
He pointed out that the 16 centimetres long knife was just millimetres away from big blood vessels in the liver and bile ducts.
"The radiologist first put tubes to take out the liver pus 100 ml a day. Tube to take out water from the chest. Gave blood transfusion and nutrition through blood called TPN and continuous psychiatrist counselling," informed Dr Dash.
"On July 19 we operated on him with all arrangements of possible inoperative problems of severe bleeding and need to cut the liver if required and the endoscopy on table. We took out the knife through a hole in the duodenum, ensured hemostasis, closed it and put a tube for feeding during the healing period," said Dr Dash.
The surgery lasted nearly three hours. Dr Dash was assisted by Gastrointestinal Surgery - Head of Department Dr Peush Sahni, Anaesthesiology, Pain Medicine and Critical Care - HoD Prof. (Dr) Rajeshwari Subramanium and her team, Gastroenterology HoD Prof. (Dr) Anoop Saraya and team, Radiology HoD Prof. Arun Kumar Gupta and team, and Psychiatry HoD Prof. (Dr) R K Chadda and his team.
The psychiatrists were constantly taking care of the patient from the date of admission on July 12 till day before surgery and after to avoid further reaction from the patient.
"There have been reports of small needles and fish bone going into the liver after perforating the duodenum. But such a big sharp knife ingestion has not been reported. We are searching for more medical literature in this regard," informed Dr Dash.
"The knife could have easily perforated the esophagus and gone into the trachea, heart or big vessels, on its journey from mouth to liver via duodenum," said he.
"The operation was not difficult by our standard. But we were ready for any eventuality like torrential bleeding from liver or cutting through liver to retrieve it and check bleeding or bile leak," said Dr Dash, adding that team effort of emergency, psychiatry, anaesthesia, covid test team, radiology, gastromedicine and surgery helped in proper management.
"Covid testing was done on the patient twice first on admission, and the second one day before surgery. Both were negative. Even though two tests were done, operating in Covid era, there remains 30 per cent risk to the surgeon and the patient," said he.
"Post-surgery, he is recovering well. The pus and chest tubes have been taken out and now he is able to eat food by mouth. He is also able to walk around, We are also watching for any delayed complications if at all occurs," informed Dr Dash, adding that the patient will be discharged soon.
(Doctor did not reveal the name of the patient so as to maintain his privacy)
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