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In a bizarre tragedy that "almost defies belief," an elderly woman had her intestines sucked out by a vacuum toilet aboard a cruise ship last September, a doctor reported in a letter to a medical journal Thursday.

Dr. J. Brendan Wynne, an orthopedic physician with the Osteopathic Medical Center in Philadelphia, said he wrote the letter to the American Medical Association to alert physicians and the public to the possible dangers of vacuum toilets, which are common aboard ships and airplanes.

"Whether this occurrence represents a malfunction of this particular vacuum system, or if this could occur with any vacuum type of toilet, I do not know," he said. "But it certainly bears further investigation."

"I realize this almost defies belief," Wynne acknowledged in a telephone interview. "Our friends wouldn't believe us when we told them and I've never heard of anything like it."

Wynne said he was vacationing aboard the Greek-registered Pegasus docked near Vancouver, British Columbia, on Sept. 22 when he responded to an emergency call aboard the ship's loudspeaker.

Wynne's wife, a registered nurse, said that when the ship's mate told them what had happened, "we thought she was hysterical."

But when the couple arrived at the woman's cabin, they found her lying on a bunk with "several feet of small intestine'' trailing behind her, Wynne said.

The woman, 70 years old and slightly obese, was alert but obviously in pain, he said. She told him that she had flushed the toilet while seated and the suction had "pulled everything out."

"Apparently," Wynne said, "her buttocks and thighs completely occluded the opening of the toilet seat, causing the full force of the vacuum to be applied to the (pelvic) area."

Wynne said the woman kept repeating, "Why didn't anybody warn me?"

A multilingual sign posted next to the toilet read in English, "This toilet operates on a vacuum system. Please do not throw any object except toilet paper."

Wynne speculated that because the woman was elderly, her pelvic muscles may have been weakened or she may have had pelvic surgery, both of which could have contributed to the accident. He said the only other cases of evisceration he has heard about occured in car accidents or falls from a great height.

Although Wynne said he did not know what happened to the woman after an ambulance crew responded to the emergency call, a check with Vancouver authorities confirmed the woman was taken to the Royal Columbian Hospital.

Dan VanKeeken, director of communications for Royal Columbian, said the woman, a Phoenix resident, was admitted to the hospital, where she was treated for 10 days and released. VanKeeken said no other information was available about the woman's present whereabouts, "but the nurse said she left looking pretty good."

Sam Malad, a spokesman for the now-defunct Neptune Cruises, which booked passengers aboard the Pegasus to accommondate overflow from Expo 86, called the incident a "real human tragedy" but said he did not know if any precautions have since been taken.

"I'm pretty sure some sort of warning is already there about not flushing when you're sitting down," he said. "I mean, that vacuum is pretty strong."

Malad said he did not know whether a lawsuit had been filed as a result of the incident.

New York representatives for Epirotiki Lines, owner of Pegasus, defered inquiries to their home office in Athens, where no one could be reached for comment. The Pegasus is currently on a South American cruise.

(cite provided by snopes)