An operation for an intestinal obstruction presented an unexpected scene to say the least for surgeons at a hospital in Bologna, Italy. By removing a mass of plant fibers which was blocking the intestine of an 82-year-old patient, they discovered… a woodlice still alive. An exceptional case, published in BMJ Case Reportswhich above all allows us to better understand a rare digestive risk in the elderly.
Beneath the unusual aspect of this discovery lies a real medical emergency: intestinal obstruction can quickly endanger the patient’s life when it interrupts the blood supply to the intestine.
It all started with four days of abdominal pain
At 82 years old, this patient was admitted to the emergency room in Bologna after four days of severe abdominal pain. Added to this pain are nausea, vomiting and persistent constipation. The tests will quickly confirm the doctors’ concerns: his white blood cells are high and several curves in the intestines (intestinal loops) are dilated.
The diagnosis is made: it is an obstruction of the small intestine caused by a solid obstacle. The emergency is real. When a segment of the intestine is blocked, its contents can no longer progress normally. And if the pressure increases enough, the blood vessels that supply the intestinal wall can in turn be compressed. The tissue then risks lacking oxygen, leading to necrosis.
The surgeons therefore decided to intervene. An open abdominal operation (laparotomy) is performed to identify and remove the obstruction.
It is at this moment that this ordinary medical intervention will take a completely unexpected turn.
At the heart of the mass, a small animal… still alive
The obstacle measures approximately 5.5 centimeters. It is a compact mass made up of plant fibers. But when the surgeons remove it, a small living animal comes out and begins to crawl on the sterile operating fields.
The specimen is collected and then analyzed in the laboratory. Its identity ultimately leaves little doubt: it is a woodlice, a small terrestrial crustacean belonging to the order Isopods.
How could such an animal find its way into the intestine and, above all, survive long enough to come out alive during the operation?
For Dr. Gérald Kierzek, emergency physician and medical director of True Medical, the explanation is based on the plant mass found in the patient.
“This very rare case is explained by the presence of a “phytobezoar” (a ball of undigested plant fibers) in the intestine, which was able to temporarily protect this small terrestrial crustacean accidentally swallowed with poorly washed vegetables or fruits. The bezoar created an intestinal obstruction, requiring emergency surgery. And it was during the extraction of this mass that the animal, still alive, came out.”.
In other words, it was not the woodlice which directly caused the occlusion. It would have been imprisoned in an agglomerate of undigested plants, itself becoming sufficiently large to block the intestinal passage.
Without this protection, the animal would likely have been quickly destroyed by stomach acids and digestive enzymes.
Behind the anecdote, a digestive problem that deserves to be taken seriously
Phytobezoar remains a rare cause of intestinal obstruction. It corresponds to an accumulation of plant matter which is not properly digested and ends up forming a compact mass in the digestive tract.
However, some people are more exposed, particularly the elderly. With age, dental difficulties or wearing dentures can make chewing less effective. Transit can also slow down and several illnesses or backgrounds can promote the formation of bezoars.
“They have a slower transit and more factors favoring bezoars, such as diabetes, hypothyroidism, history of digestive surgery or even constipation.
In this context, a mass of plant fibers can gradually accumulate until it obstructs the intestine. The story of the woodlice is therefore spectacular, but it should not make us forget the essential: it was the occlusion that constituted the medical emergency.
Pain, vomiting, swollen stomach: when should you worry?
An intestinal obstruction can have many causes: tumor, hernia, volvulus, adhesions after surgery or even a foreign body. Its manifestations must be taken seriously.
Several signs are particularly evocative:
- Intense and worsening abdominal pain;
- A swollen and sensitive stomach;
- Nausea and vomiting;
- A cessation of stools and gas.
The combination of these symptoms, particularly when it sets in or worsens rapidly, warrants urgent medical attention.
“These symptoms require an emergency consultation (SAMU, call 15 or emergency service), because an untreated obstruction can lead to suffering, or even necrosis, of the intestine..
In these situations, it is therefore better not to wait for the pain to pass spontaneously. An obstruction can progress quickly and require intervention to free the intestine before the tissues are permanently damaged.
A woodlice in the intestine: an extraordinary story, but nothing to panic about
However, should we fear every fruit or vegetable likely to have harbored a small arthropod? No. The case reported in Bologna is absolutely exceptional.
A few simple precautions nevertheless remain relevant: wash fruits and vegetables carefully, particularly when they are eaten raw or lightly cooked, and take the time to chew the food thoroughly.
Dr Gérald Kierzek also recalls:
“To protect yourself, simply apply simple food hygiene measures: wash fruits and vegetables well (especially if they are eaten raw or lightly cooked), avoid eating very fibrous plants in large quantities without chewing properly, and consult quickly in the event of persistent abdominal pain with vomiting and constipation..
And above all, the story of this woodlice should not fuel disproportionate concern. The emergency doctor’s conclusion is intended to be reassuring:
“This type of incident remains exceptional; In the vast majority of cases, a small insect or arthropod swallowed by mistake is simply digested without consequence..
An astonishing story, therefore, but the real lesson is elsewhere: faced with significant abdominal pain accompanied by vomiting and a cessation of stools and gas, this is not the insect you should look for. This is an emergency that must not be missed.