Santol Seed: The Seasonal Killer is on the Loose Again
John Lloyd Fonte, MD
July 18, 2012
On July 11, 2012, J. E., a 53-year-old female came in at the Ospital ng Maynila Department of Surgery Emergency Room due to severe abdominal pain. She was in agonizing pain, was febrile, and was breathing faster than normal. Her heart beat was also fast. These are signs of infection, of sepsis. She claimed that her abdominal pain started 3 days prior to consult, but was intermittent and not so severe so she did not seek any medical help. The same happened 2 days prior to consult, so she just ignored the pain. The following day, she could no longer tolerate the pain so she decided to go to the hospital.
The patient also claimed that 2 days prior to the start of the symptoms, she, together with her 2 sons, ate santol of the Bankok Variety. She said that she didn’t want the seeds to put to waste because they tasted very sweet so she swallowed them. The patient swallowed a total of 5 santol seeds. Apparently, nothing happened on the first 2 days upon ingestion of the santol seeds, until the third day when she started to feel the pain in her inside.
On further examination, the patient had generalized abdominal pain. All areas of her abdomen were tender, that is painful to touch, especially the left lower part. At this point our impression was a surgical abdomen secondary to perforated intestine secondary to santol seed ingestion. Our differential diagnoses included perforated diveticulitis and perforated appendicitis. We then booked her for an emergency exploratory laparotomy.
In the operation, we noted that her entire abdomen was filled with liquid stool which causes her generalized abdominal pain. We also noted where it came from. There were 2 holes at the distal part of her intestine, in what we call the sigmoid colon. On palpation, we also noted hard objects inside her intestine with the shape of a santol seed. The decision made was to resect that part of the intestine with holes, close the distal part and bring the proximal part out where she temporarily would have her bowel movement. That is what we call colostomy. The next couple of days were also hard for the patient because she had to overcome the sepsis that she already had upon consultation. After a couple days more, the patient was discharged with the plan of another operation to re-connect the intestines after several weeks.
This anecdote should teach everyone who is fond of eating santol, especially now that it is again its season. DO NOT TRY TO SWALLOW ITS SEEDS! BEWARE! You might end up carrying with you a bag of feces. Or worse, it would be the last time you taste the sweetness of santol.
Picture showing the holes in the intestine with feces coming out.
Picture of the part of the intestine that was removed together with the location of the santol seeds.
Picture of the part of the intestine that is removed showing the two holes on the middle and the left side.
ROJoson 2012 Advisory – Beware of Santol Seed Swallowing
Beware of Santol Seed Swallowing
A 2012 Advisory from Dr Rey Joson and ROJOSON Medical Clinic
It is santol season once again.
Do NOT swallow the santol seeds.
Swallowed santol seeds can cause premature death by obstructing and perforating the intestines.
If santol seeds are accidentally swallowed, watch out for abdominal pain. If abdominal pain occurs, consult an abdominal surgeon (general surgeon) right away who will give the necessary advice on what to do next.
Swallowing santol seeds is a totally preventable cause of a health problem and death.
Advice: do NOT swallow santol seeds!
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