New Delhi, July 27
After a uncommon and difficult three-hour surgical procedure, docs on the AIIMS right here efficiently eliminated a 20-cm-long kitchen knife from a person’s liver who had bizarrely swallowed it in a match of psychosis.
The docs mentioned they have been perplexed as to how the 28-year-old gulped down the saw-edged knife with none injury being brought on to his wind-pipe, lungs, coronary heart and different important organs.
“The knife might have simply perforated the esophagus and gone in to the trachea, coronary heart or large vessels, on its journey from mouth to liver through duodenum,” mentioned Dr Nihar Ranjan Sprint, professor of Gastrointestinal Surgical procedure and Liver Transplant at AIIMS.
He mentioned: “We now have searched the literature, however such large, sharp knife ingestion has not been reported. We’re trying to find extra literature”. He mentioned there are stories of small needles and fish bones going into liver after perforating duodenum.
The person, a day by day wage employee from Palwal in Haryana, has a historical past of psychosis and had a behavior of smoking hashish.
“He was not an addict however took hashish very often,” mentioned the physician.
The person informed the docs in the course of the coronavirus lockdown 1.5 months in the past he felt “consuming a knife” when he was within the kitchen. “He tried to chew it and at last gulped it down with water,” docs mentioned.
He had no issues for a month. However subsequently, he developed points like issue in consuming, weight reduction, fever, stomach ache that quickly turned insufferable, the docs mentioned.
He was taken to native hospitals and was referred to the Safdarjung hospital in Delhi.
“An ultrasound and an X-ray of the stomach revealed blade of a kitchen knife caught within the liver. Anticipating the challenges concerned in eradicating the thing, docs there referred the affected person to the Gastrointestinal Surgical procedure and Liver Transplant division at AIIMS,” Dr Sprint mentioned.
The affected person got here to the emergency of the AIIMS on July 12. A COVID-19 take a look at was achieved to rule out coronavirus an infection. The stories got here out adverse.
Whereas the affected person was admitted within the emergency, an ultrasound, CT scan and different investigations have been carried out to know the precise place of the knife, its relation to the important organs and the issues it had brought on, the docs mentioned. “On CT scan, we discovered the blade of the knife was solely contained in the liver and the deal with contained in the duodenum, which is the primary a part of the small gut.
“The knife truly had perforated the duodenum and had gone into the liver. It had led to bleeding, an infection, abscess formation within the liver and sepsis. His hemoglobin stage was very low. A sepsis had set in, there was lack of weight and water had gathered in his proper chest,” Dr Sprint elaborated.
“An instantaneous surgical procedure was not doable,” he mentioned, including eradicating the knife by way of endoscopy was dominated out because it was very dangerous and will have brought on accidents to the organs.
Medical doctors determined to first management the sepsis and gave him blood transfusion. He was placed on excessive antibiotics and was beneath crucial care.
The docs mentioned beneath X-ray steerage, a tube was put contained in the liver to empty the pus that sucked round 100 ml pus on a regular basis for 4 to 5 days.
One other tube was inserted to take out the water from the chest, Dr Sprint defined.
He mentioned the person was given vitamin intravenously as he was not in a situation to take meals orally. He was additionally being supplied psychiatric counselling all all through.
After seven days, although his situation improved to a sure extent, the sepsis couldn’t be managed solely.
“It was then that we determined to take him for surgical procedure. Challenges in the course of the surgical procedure have been the potential of heavy bleeding, injuring the liver, controlling bleeding after eradicating the knife and to do it as shortly as doable with minimal issues.
“When a affected person is septic and anemic, giving anesthesia for an extended interval and conducting longer procedures might flip deadly,” Dr Sprint mentioned.
In a difficult surgical procedure lasting three hours, the knife was eliminated by opening the gut on July 19, Sprint mentioned. A group of docs from the division of Anaesthesia, Vital Care, Radiology and Gastroenterology moreover the Gastrointestinal Surgical procedure and Liver Transplant have been additionally concerned within the surgical procedure and the knife was pulled out beneath ultrasound steerage.
“The affected person was within the ICU for seven days. He’s out of hazard now and out of ICU care,” Dr Sprint mentioned.
“We had put a meals pipe in the course of the surgical procedure in his stomach and thru that tube he’s being given meals. Very quickly we’ll begin giving him meals orally. He’s aware and capable of stroll round. He’s being given psychiatric counselling,” he mentioned. PTI