Severe abdominal pain brought a 55-year-old fisherman to an emergency department in Bangladesh. At first glance, there was nothing to suggest what the doctors were about to find: his abdomen was rigid and tender, and his heart rate was slightly elevated, at 110 beats per minute.
The man told the doctors that a strange accident had happened the previous day while he was fishing. According to his account, an eel had entered through the lower part of his lungi, a traditional garment resembling a long skirt, and from there had managed to enter his anal canal. The man decided not to seek medical attention immediately because he expected the animal to come out on its own.
By the time he finally went to the hospital, he had been experiencing severe abdominal pain for about five hours. The doctors ordered an X-ray and found signs consistent with an intestinal perforation and peritonitis. But there was something else: a shadow with an unusual shape appeared on the right side of the abdomen, corresponding to the path of an elongated object.
The situation called for urgent action. Peritonitis can occur when intestinal contents enter the abdominal cavity and cause severe inflammation, so the doctors administered antibiotics and fluids and decided to perform an emergency laparotomy.
During the operation, they discovered that the eel had pierced the sigmoid colon, the final part of the large intestine, near its junction with the rectum. The opening was approximately 5 centimeters wide, and the animal had managed to pass from the intestine into the peritoneal cavity.
Then they found the most unexpected part of the case: the eel was still alive. The animal was approximately 65 centimeters long and was removed from the abdominal cavity. The doctors hypothesized that it may have passed through the intestinal wall in order to continue breathing inside the peritoneal cavity, although the exact mechanism by which it managed to do so remains difficult to explain.
The perforation had put the patient at risk of a serious infection. To prevent intestinal contents from continuing to leak into the abdominal cavity, the surgeons had to perform a sigmoid colostomy, creating an opening from the intestine to the outside of the abdomen.
The case was published in International Journal of Surgery Case Reports under the title Not your typical abdominal pain: Case report of a fisherman presenting to the trauma & emergency surgery department with intestinal perforation due to an eel fish. The authors described intestinal perforation caused by a live animal as an extremely rare event.
Fortunately, the story had a happy ending. After surgery, the man was symptom-free and had no recorded postoperative complications. He was discharged four days after admission. The medical report even includes a photograph of the extracted eel and a video of the operation.