ascaris

i know why i'm not a microbiologist. in one word, worms.

i was doing a gastroscopy. the patient had a previous gastroenterostomy (small bowel attached to the stomach) somewhere else for unknown reason. the result was, over and above the pyloris (the normal stomach outlet) which was normal, he had another stoma which had an afferent loop and an efferent loop of small bowel. i took a look at all three pipes leaving the stomach, intubating them one at a time.

in the efferent loop is where i saw them!! ascaris!! (see above picture to fully appreciate this little critter). they seemed pissed off that the patient was npo because they were writhing around and moving like mad. even worms get hungry. obviously every one gathered around to take a look. i think it has to do with the fascination of all that is gross.

i just wanted to run. i think i now understand that some people have a rather robust vaso vagal reaction to blood etc, because the same happens with me when confronted with worms.

one of the sisters suggested i take a biopsy. why i wondered. it's not as if i have any doubt as to what it is i'm looking at. anyway, can you imagine how the thing will go crazy if i start taking bites out of it. biopsy is just out of the question here.

i woke him up, gave him deworming treatment and sent him on his merry way.

fettuchini

surgeons are supposed to be tough. surgeons have seen some pretty wierd stuff, but occasionally you see something that really churns the stomach.

the patient came in after being involved in a car accident. he had an acute abdomen, but was otherwise stable. x-rays confirmed free air in the abdomen. easy call. the patient went to theater.

we opened the abdomen. it was full of intestinal content. not too surprising. and then...lying in this soup, free in the abdomen we found a meter long tape worm! i'm not embarrased to say i gagged. i threw it in a kidney dish where it entertained us with its peristaltic movements.

i found the perforation. it was mid small bowel. in the lumen i saw two more strands of fettuchini. i removed them. each was also about a meter long. (note at this point that in no way do i advocate surgery as treatment for tapeworm. i mean poor surgeons! that's just gross). soon all three worms were in the kidney dish writhing around merrily. they pretty much filled the entire dish.

the rest was easy. repaire, rinse, close up and go home.

but i have not felt comfortable about eating fettuchini since then.