Peeping thread from a laparotomy scar: Misery of an old man

Abstract

Despite availability of modern methods of various surgical techniques for treating complicated patients, there are still some unreported incidents in day to day practice where simple surgical procedure ends up in unwanted complications. This may be attributed sometimes to the negligence of treating doctors and sometime to the patient himself. We present here one such case where unnecessary morbidity added to the patient after surgery.

INTRODUCTION

The medical science has achieved unbelievable dimensions with new technolologies and techniques adding daily to the armamentarium of doctors for diagnosing and treating patients. Despite this revolutionary progress there are few examples which are almost as unbelievable as the rapid progress in science which merely reflects the negligence and carelessness of the doctors on one hand and the misery of the patient who suffers on the other hand.

We witnessed one such example where a 60-year-old man came to us with abdominal pain, nausea and constipation since last 3 months. He was a tobacco user but nonalcoholic. There was no history of diabetes, hypertension, or CAD. He had suffered from intestinal perforation and had undergone laparotomy about three years back. As he did not have any past records we could not ascertain the cause of perforation. He was emaciated and his vitals were stable. Chest examination was normal. The abdomen was scaphoid with a large central laporotomy scar. The liver was palpable and there was no spleen or free fluid. However to our surprise, on close inspection we found a thread moving in and out of the scar. It was the suture left behind by the previous surgeons [Figure 1]. The patient was treated with antispasmodic and antiemetic drugs. An antihelminthic was added keeping in view his malnourishment and abdominal pain. Another surprise came next morning when the patient vomited around five adult worms of Ascaris lumbricoides. His symptoms got relieved after 3 days but now he was anxious about the peeping suture which was dancing in and out of the scar with respiratory movements of his abdomen. The surgeon was called who decided to cut away the thread and hence relieved the patient of his anxiety and iatrogenic induced misery.

Figure 1.

Peeping suture from a laparotomy scar

CONCLUSION

This case highlights the fact that despite revolutionary development in medical science there exist a segment of patients who become the guinea pigs and suffer from unwanted complications of various surgical procedures probably because of the negligence on part of the doctor and sometimes the patient himself. Further, it reminds us that worms remain our bete noire and need for better geriatric care in most of the developing nations.