You couldn’t do again it if you tried

A 42-year-old man was stabbed in the right chest and was mildly hypotensive on arrival. A chest tube was inserted and returned 500 mL of blood. After an ultrasound was positive for fluid, thoracoscopy was performed, and a defect in the diaphragm was seen prompting a laparotomy. Anesthesiology inserted a right internal jugular catheter without ultrasound guidance. The amount of fluid draining from the chest tube increased immediately. A chest x-ray was taken. Because of suspicion that the catheter may have been placed inside the lumen of the chest tube [white arrow in x-ray below], methylene blue dye was given through the central line and was immediately seen draining through the chest tube. The central line was removed and the patient recovered without complications. [Reference]

Don’t fish for a fishbone with a spoon

 

While trying to dislodge a fish bone stuck in her throat, a woman in China swallowed a 5-inch-long metal spoon. Because it was a holiday, she waited several days before going to a hospital. An x-ray showed the spoon which was removed by endoscopy. Only minor irritation of the stomach lining was seen. I was more interested in the fate of the fishbone, which could have led to a serious infection had it perforated the pharynx or esophagus, but this was not discussed in any of the articles about the case [for example, here and here].

This is not what I mean when I say, “Use your head”

A 6-inch handheld shower head was removed from the rectum of a young man in India. He said he had “accidentally slipped” in the bathroom causing the problem. Emergency medicine physicians and surgeons are familiar with this kind of story. Most people who have retained foreign bodies in their rectums are reluctant to admit they were doing it for sexual gratification. Just about anything you can imagine has been lodged in the rectum, but what probably hasn’t been described before is a shower head which had to be detached from the pipe connecting it to the wall in order to get the patient to the hospital.

The authors of the case report, surgeons from Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research in New Delhi, thoughtfully included an arrow and an asterisk to identify the shower head on this screenshot from a CT scan.

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 19,000 followers on Twitter