Can Your Stomach Explode?
Imagine this: Your patient is lying on an operating table, ready to have his stomach removed. The anesthesiologist puts the patient to sleep, and you're ready to start the operation. Everything goes smoothly, you make an incision, enter his abdominal cavity, and at the exact moment you try to cauterize the patient's blood vessel, a huge ball of fire emerges from the patient's abdomen.
The nurses scream, your medical student faints, and you barely escape without severe burns to your hands and face.
But how could this happen?
Let me explain
SE was a 35-year-old man with years of chronic, untreated gastrointestinal problems. He had gastritis, an inflammation of the stomach lining most commonly caused by Helicobacter pylori, a common bacterium that lives in the stomachs of about 50 percent of the world's population.
For most people, the presence of H. pylori requires antibiotic treatment only if it causes gastritis or peptic ulcers. SE, of course, never visited his family medicine doctor and never knew that his gastritis could and should be treated. He also had constipation, frequent abdominal pain, bloating, and flatulence (farts).
One day, his gastritis worsened so much that he had to call in sick and decided that enough was enough. He’s going to take care of his health.
He visited his GP, who prescribed him antibiotics along with pantoprazole, a medication that belongs to proton pump inhibitors, which lower the acidity of gastric juice. He was also recommended a strict diet to relieve his bloating and flatulence. Such symptoms are most commonly caused by the fermentation of food by gut bacteria, especially when digesting fiber, lactose, or poorly absorbed carbohydrates.
Although H. pylori causes ulcers by increasing gastric acid concentration, it can paradoxically sometimes lower it, which allows bacteria you ingest to pass through the stomach unharmed and settle into your colon, where they cause further food fermentation and gas build-up.
SE didn’t change his diet, and thought that the antibiotics his doctor prescribed him could completely relieve all of his symptoms. After a few weeks, his symptoms worsened, and he was referred to a gastroenterology clinic, where a gastroscopy was done. Gastroscopy is a procedure in which a thin tube with a camera on its end is inserted through your mouth into your stomach to visualize the pathological processes that take place.
What the doctors found was shocking…
SE had peptic ulcers so extensive and severe that surgical removal of the whole stomach, called total gastrectomy, had to be performed. SE reluctantly agreed, and five months later, he was put under anesthesia in order to be operated on.
During a total gastrectomy, the stomach is completely removed, and the lower part of the esophagus is tied to the beginning of the small intestine. The stomach is a highly vascularised organ, meaning it has a lot of blood vessels that keep it alive and functioning. Along with the scalpel, the most common surgical instrument is the electrocauter- a device that transforms electricity into heat so any bleeding can be immediately stopped by coagulating the small blood vessels.
As soon as the device got close to the patient's stomach, the built-up intestinal gases from bacterial fermentation, like hydrogen and methane, ignited, causing a sudden explosion.
After the initial shock, the surgical team acted quickly. They extinguished the fire with a fire extinguisher. Just kidding, they used a sterile saline solution. The fire was dramatic but brief, so no other organs except his stomach, which he agreed to remove anyway (again, just kidding), were damaged.
The surgery continued without further complications.
Today, SE is alive and well. He drastically changed his diet, not because he wanted to, but because he had to. After a total gastrectomy, patients must eat small meals because the food passes directly through the esophagus into the small intestine without being properly digested in the stomach.
SE still tells the story of how his stomach was flambéed in the operating room.