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Patient claims he can play songs by passing flatus
    Differential Diagnosis[Top] [Nav]
highly developed ability to control anal sphincters
    Discussion -- not available online[Top] [Nav]
    Erratum in printed version[Top] [Nav]
       *"Explosion" should be added to the index.
    Update Comments[Top] [Nav]
  • Humorous, yet scholarly discussion of flatus and associated physiology. [102]
  • A professor in medical school described the typical host for gallbladder disease as female, fair, fat, forty, and flatulent. Bean prints, but gives no source for, the following poem, an illustration of what he calls "the dowager's plight," which suggests someone older than 40:
    When I sat by the duchess at tea,
    It was just as I knew it would be,
       Her rumblings abdominal
       Were really phenomenal;
    And everyone thought it was me.
    (Also appears on page 75 of the Bolin & Stanton book.) [103]
  • Do you think it is possible for a human to sing two musical notes at one time? Tuva lies just north of Mongolia and southwest of Lake Baikal. The Inner Asian singing style called "hoomi" sounds like a bagpipe: a drone and a melody are produced simultaneously. The article, although delightful, does not say how it is done. [104]
  • Emphasizes that the composition of gas in the colon is highly variable, and can range from the inert to the explosive. The paper presents a design for a sigmoidoscope incapable of causing explosions. [105]
  • The paper presents one case, and is followed by a discussion in which two physicians briefly describe their cases:
    1. "When the current was turned on this last time, there was a sudden violent explosion within the bowel causing a blue flame to shoot out the end of the sigmoidoscope for a distance of one or two feet. A loud muffled sound that was audible into the adjoining room accompanied the explosion. The patient immediately screamed and started to climb off the examining table. After he was calmed and reassured the sigmoidoscope was reinserted into the bowel..." The patient developed a massive pneumoperitoneum, required an operation, but lived.
    2. "In my office about one week ago[,] when the foot switch was closed, a very minor explosion occurred, and the sound was almost exactly that which is produced by lighting an oxyacetylene torch." Within about 30 minutes, the patient developed muscle spasm and rebound tenderness over the left lower quadrant, but never developed pneumoperitoneum. The symptoms lasted a week. The author opines that stretching of the bowel wall was responsible for the symptoms.
    3. "... there was a loud explosion. Some of the contents of the bowel were thrown through the scope far enough not only to hit me in the face, but also the wall; so it was of no minor importance at all."
  • "One evening [the patient] had taken his wife to the cinema. There, in the darkness, feeling inclined to smoke, he had taken out a cigarette, and put it between his lips; he struck a match, bringing it up in his cupped fingers. Just at that moment a violent eructation occurred. To his alarm and astonishment, and of those seated near him, there was a flash and a sharp explosion; the cigarette was blown from his lips away across several rows of seats; his moustache was singed, and his lips and fingers burnt. In pain and confusion he had hurriedly to leave the cinema." [107]
  • "The patient was playing bridge with friends when he was offered a light for his cigarette by his partner across the table. As he leant across the table he felt an undeniable necessity to belch. Unfortunately, he attempted to do this discretely through his nose. He astonished the company by producing two fan-shaped flames from his nostrils. His partner, who accompanied him to the casualty department, described the incident as `just like a dragon, doctor.'" [108]
  • Says airway fires can occur as a result of laser treatment of airway disorders done in the presence of flammable anesthetic gasses. One of the authors told me that tantalum bronchograms have led to explosions in the past, but I've not yet gone searching for references. [109]
  • A patient's nitroglycerin patch exploded when a 320 J defibrillation was applied to the chest: "a loud `explosion,' a flash, and a puff of yellow smoke, which startled all present." It may not have been an actual explosion, but an electrical arc between the paddle and the aluminum covering of the nitro patch. No damage to the patient was noted, although the resuscitation effort was unsuccessful. [110]
    Footnotes in Print Edition[Top] [Nav]
    (1) Flatulence.
  Levitt MD, Bond JH.   Annu Rev Med 1980;31:127-37.  Pubmed  Similars
    (2) Explosion of hydrogen gas in the colon during proctosigmoidoscopy.
  Bond JH, Levy M, et al.   Gastrointest Endosc 1976 Aug;23(1):41-2.  Pubmed  Similars
    (3) The quantity and composition of human colonic flatus.
  Kirk E.   Gastroenterology. 1949;12:782-794.
    New References[Top] [Nav]

Flatus and other gas effects
    101.Follow-up of a flatulent patient.
  Levitt MD.   Dig Dis Sci 1979 Aug;24(8):652-4.  Pubmed+Abstract  Similars
    102.Wind Breaks.
  Bolin T, Stanton R. New York: Bantam, 1995: 86 pp.   Amazon.com
    103.Rare Diseases and Lesions.
  Bean WB. Springfield, IL: Thomas, 1967: 30.
    104.Tracking the throat-singers of Tuva.
  Levin T.   World Monitor. 1991;4(6):56-62.

    105.Explosions during lower bowel electrosurgery: a method of prevention.
  Levy EI.   Am J Surg. 1954;88:754-758.
    106.Explosion in the colon during electrodessication of polyps.
  Carter HG.   Am J Surg. 1952;84:514-517.
    107.An explosive eructation.
  East T.   Lancet. 1934;2:252-253.
    108.Combustible gases generated in the alimentary tract and other hollow viscera and their relationship to explosions occurring during anesthesia.
  Galley AH.   Br J Anaesth. 1954;26:189-193.
    109.Cardiac Arrest: The Science and Practice of Resuscitation Medicine.
  Paradis A, Halperin HR, Nowak RM (eds). Baltimore: William & Wilkins, 1996: 981 pp.   Amazon.com
    110.Does nitroglycerin explode? [letter].
  Babka JC.   N Engl J Med 1983 Aug 11;309(6):379.  Pubmed  Similars
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:34 PDT on July 4, 2000.[Top]

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