Diagnostic dilemma: Fisher's colon punctured by eel that snuck in through his rectum

A 55-year-old man from Bangladesh sought emergency medical care due to severe abdominal pain that had been present for five hours prior to his visit. Upon examination, doctors found his temperature and blood pressure to be within normal ranges, but his heart rate was slightly elevated at 110 beats per minute. The patient explained that an eel had entered his rectum through the bottom of his lungi, a long skirt commonly worn by men in Bangladesh, and subsequently traveled into his anal canal.

This event had occurred the previous day, and the man did not seek treatment immediately, hoping the eel would naturally exit his body.

During the physical examination, the patient's abdomen was rigid and tender, leading doctors to order an X-ray. The X-ray revealed a crescent-shaped gas shadow on the right side of the abdomen, indicating the potential presence of peritonitis, inflammation of the abdominal lining. Peritonitis is typically caused by bacterial or fungal infections, but it can also develop if fluids from other organs leak into the peritoneum.

If left untreated, peritonitis can result in a life-threatening infection that spreads rapidly throughout the body.

The doctors treated the patient with IV antibiotics, fluids, and anti-ulcer medications to help repair the outer mucosal layers of his organs and prevent further tissue damage. Given the severity of the peritonitis, they determined that the patient was at risk of septicemia, or blood poisoning, where pathogens enter the bloodstream.

To address the issue, they performed an immediate laparotomy, a surgical procedure that creates an opening in the abdominal wall to access the pelvic organs. Through this incision, they extracted the eel from the patient's peritoneal cavity, the space surrounding his abdominal organs enclosed by the peritoneum.

The eel, which measured nearly 2.2 feet (0.6 meters) long, was still alive during the procedure. The doctors hypothesized that the eel had been able to continue breathing by puncturing through the wall of the man's colon and entering the peritoneal cavity, which contains a fluid mainly composed of water, along with glucose, electrolytes, proteins, enzymes, white blood cells, and urea.

To prevent further infection, the surgeons performed a sigmoid colostomy, creating an opening in the man's abdomen to allow for the passage of the contents of his large intestine, thus bypassing the damaged section of his sigmoid colon. The patient recovered within four days and was discharged from the hospital. The case is unique due to the uncommon occurrence of traumatic intestine perforation by a live animal, and the reported existence of a similar case involving a live eel in Hong Kong.