In November 2014, a 48-year-old man from northeast India visited the Institute of Liver and Biliary Sciences in the capital, complaining of “abdominal discomfort”. An examination revealed he was suffering from anaemia — a condition in which the blood doesn’t have enough healthy red blood cells. But further examination revealed something more: A tapeworm inside his intestine was eating up nutrients, which led to the anaemia. When doctors performed an endoscopy inside the digestive tract, they saw something they had never seen before: A 6-foot tapeworm, curled up inside the intestine.
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An endoscopy was performed, and the tapeworm was removed through the mouth.
The entire procedure, which took 1 hour-20 minutes, has now been described in detail in The New England Journal of Medicine, while the video footage of the procedure has been featured on the NEJM website.
“It was just a simple case of anaemia, and the patient complained of abdominal discomfort. His haemoglobin was 9.8. When we conducted colonoscopy to examine the inner lining of the large intestine, we saw a segment of the worm moving around the rectum,” said Dr C A Philips, who was then senior fellow with the ILBS and now heads the liver department and transplant unit in PVS Hospital, Kochi.
It was when the team performed an upper gastrointestinal endoscopy that they saw the huge worm curled up in the upper part of the small intestine. “Usually we just give a simple medicine to kill the worm. Since we saw a segment of the tapeworm in the small intestine, we went ahead with the endoscopy, which is rarely performed in such cases,” said Dr Philips.
The doctors used blunt forceps and the tapeworm was removed in one go, said Dr Amrish Sahney, who works at ILBS. Doctors said they had to perform it very carefully, to ensure the tapeworm does not break.
“It was 188 cm long. We had to ensure it does not break, because if it does, the tapeworm will release eggs, pierce into the intestinal walls, enter the blood system and eventually cause severe infection inside the brain. This was the most challenging part of the procedure,” said Dr Philips.
“We caught the worm from its head, in the upper part of the small intestine. We then pulled the entire thing through the mouth. It was done carefully. We completed the procedure successfully in an hour and 20 minutes,” said Dr Philips.
“We very lucky the worm didn’t break. Tapeworms are common but removing it in such a unique way is rare. If you look at the literature for long tapeworm, you won’t find anything this long,” said Dr Sahney.