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Date: Sun, 5 May 1996 13:47:12 -0400 (EDT)
From: "Ian A. York" <iayork@panix.com>

Tb. A patient's intestine explodes from cauterization during surgery

due to gas.

There are 8 reports in Medline on this.

Gross E. Jurim O. Krausz M.
[Diathermy-induced gas explosion in the intestinal tract]. [Hebrew] Harefuah. 123(1-2):12-3, 72, 71, 1992 Abstract

Surgical diathermy is widely used in modern operating rooms, although explosion in the gastrointestinal tract is a known serious complication. We report a case of colonic explosion following use of diathermy. Based on our experience and the available data, it is recommended that in cases of gastrointestinal tract obstruction, poor bowel preparation or following use of oral mannitol for bowel preparation, diathermy should be avoided in opening the gastrointestinal lumen.

Joyce FS. Rasmussen TN.
Gas explosion during diathermy gastrotomy. Gastroenterology. 96(2 Pt 1):530-1, 1989 Abstract

The first report of rupture of the stomach due to diathermy-elicited gas explosion during gastrotomy in a patient with intestinal ischemia resulting in obstruction and jejunal and gastric dilatation is presented. In the obstructed stomach or small bowel, a proliferation of hydrogen- and methane-producing bacteria can occur, leading to the accumulation of these combustible gases in explosive concentrations. In cases of gastrointestinal tract obstruction, the diathermy knife should not be used in entering the gastrointestinal lumen.

Bonnet YY. Haberer JP. Schutz R. Simon R. Vanwynsberghe B. Mercier R.
[Explosion of intestinal gas during surgery]. [French] Annales Francaises d Anesthesie et de Reanimation. 2(6):431-5, 1983. Abstract

Two cases of colonic gas explosion during surgery are reported. The treatment of the lesions required a partial colectomy in one case and a total colectomy in the other case. The different factors involved in such accidents are discussed. Three factors are necessary to trigger off an explosion of intestinal gases: the presence of combustible gases (hydrogen, methane), the presence of combustive gases (oxygen, nitrous oxide) and an initiating heat source (endoscopic or surgical electrocautery). The mannitol used for bowel cleansing undergoes partial colonic bacterial fermentation increasing the intraluminal concentration of hydrogen. During anaesthesia the oxygen-nitrous oxide mixture increases the intestinal concentration of these two major combustive gases. Electrocautery provides the spark triggering the explosion. The use of mannitol for colonic preparation should be questioned; the use of electrocautery to open the colon is advised against.