A Death from Santol Seed Ingestion – September, 2011

I received this report from Dr. John Lloyd of the Department of Surgery of Ospital ng Maynila Medical Center (OMMC).


For the past 10 years, OMMC Department of Surgery usually has an annual average of 2 patients being operated on for intestinal perforation secondary to santol seed ingestion.


This is the first case in 2011 (September) and unfortunately, this patient died of the complication of the santol seed ingestion.


“Patient (IM), a 49-year-old male with a history of ingestion of a single santol seed of the “bangkok” variety 4 days prior to occurrence of symptom. Patient then had hypogastric pain but only consulted a day after the onset of symptom.


Intra-operatively, generalized fecaloid abscess formation was noted, and we saw a santol seed about to come out on a distal sigmoid perforation. No other foreign body was palpated on the entire gastrointestinal tract when we did a bowel run.


The patient was in severe sepsis already preoperatively and intra-operatively was tachycardic, 140  cardiac rate, with highest blood pressure of only 90/60. What we did was just to bring out the perforation on a sigmoid loop colostomy by mobilizing the sigmoid up to the mid-descending colon and down to the upper half of the rectum.


Unfortunately, patient succumbed to death on the 3rd post-operative day.”




Below is an intraoperative picture showing the single santol seed culprit and the bowel perforation.


The black arrows identify the single santol seed culprit for the intestinal perforation pointed by the blue arrow.

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