New Delhi, July 27
After a uncommon and difficult three-hour surgical procedure, medical doctors 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 medical doctors stated they have been perplexed as to how the 28-year-old gulped down the saw-edged knife with none harm being prompted to his wind-pipe, lungs, coronary heart and different important organs.
“The knife could have easily perforated the esophagus and gone in to the trachea, heart or big vessels, on its journey from mouth to liver via duodenum,” stated Dr Nihar Ranjan Dash, professor of Gastrointestinal Surgery and Liver Transplant at AIIMS.
He stated: “We have searched the literature, but such big, sharp knife ingestion has not been reported. We are searching for more literature”. He stated there are reviews of small needles and fish bones going into liver after perforating duodenum.
The man, a every 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 but took cannabis quite often,” stated the physician.
The man advised the medical doctors in the course of the coronavirus lockdown 1.5 months in the past he felt “eating a knife” when he was within the kitchen. “He tried to chew it and finally gulped it down with water,” medical doctors stated.
He had no issues for a month. But subsequently, he developed points like issue in consuming, weight reduction, fever, stomach ache that quickly grew to become insufferable, the medical doctors stated.
He was taken to native hospitals and was referred to the Safdarjung hospital in Delhi.
“An ultrasound and an X-ray of the abdomen revealed blade of a kitchen knife stuck in the liver. Anticipating the challenges involved in removing the object, doctors there referred the patient to the Gastrointestinal Surgery and Liver Transplant department at AIIMS,” Dr Dash stated.
The affected person got here to the emergency of the AIIMS on July 12. A COVID-19 take a look at was carried out to rule out coronavirus an infection. The reviews got here out detrimental.
While 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 prompted, the medical doctors stated. “On CT scan, we discovered the blade of the knife was totally contained in the liver and the deal with contained in the duodenum, which is the primary a part of the small gut.
“The knife actually had perforated the duodenum and had gone into the liver. It had led to bleeding, infection, abscess formation in the liver and sepsis. His hemoglobin level was very low. A sepsis had set in, there was loss of weight and water had accumulated in his right chest,” Dr Dash elaborated.
“An immediate surgery was not possible,” he stated, including eradicating the knife via endoscopy was dominated out because it was very dangerous and will have prompted accidents to the organs.
Doctors determined to first management the sepsis and gave him blood transfusion. He was placed on excessive antibiotics and was beneath crucial care.
The medical doctors stated beneath X-ray steering, 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.
Another tube was inserted to take out the water from the chest, Dr Dash defined.
He stated 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 totally.
“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 rapidly as attainable with minimal issues.
“When a patient is septic and anemic, giving anesthesia for a longer period and conducting longer procedures could turn fatal,” Dr Dash stated.
In a difficult surgical procedure lasting three hours, the knife was eliminated by opening the gut on July 19, Dash stated. A group of medical doctors from the division of Anaesthesia, Critical Care, Radiology and Gastroenterology moreover the Gastrointestinal Surgery and Liver Transplant have been additionally concerned within the surgical procedure and the knife was pulled out beneath ultrasound steering.
“The patient was in the ICU for seven days. He is out of danger now and out of ICU care,” Dr Dash stated.
“We had put a food pipe during the surgery in his abdomen and through that tube he is being given food. Very soon we will start giving him food orally. He is conscious and able to walk around. He is being given psychiatric counselling,” he stated. PTI