A tapeworm, a blade, and four more clinical ambushes

A live tapeworm was pulled from a man's groin during hernia surgery. A metal cutter blade was hiding beside another patient's eye. Elsewhere, propofol produced a posture that looked like a seizure, a piece of betel nut mimicked a bronchial abscess, and a pancreatic tumor announced itself as 18 months of watery diarrhea. These are six case reports published between July 6 and July 17, 2026, in the July issues of BMJ Case Reports and the New England Journal of Medicine. 1 2

During repair of a right inguinal hernia, surgeons found a live tapeworm in the peritoneal cavity of a 71-year-old man. It was about 10 inches long and still undulated after removal. The finding was not entirely new: four years earlier, a 7-inch tapeworm had been removed during repair of a left inguinal hernia. He had received no antiparasitic treatment between the operations. 3 4

The patient had no symptoms beyond a painless groin bulge. He had no eosinophilia to hint at a parasitic infection. Polymerase-chain-reaction testing identified the worm as Spirometra erinaceieuropaei, confirming sparganosis. When asked about possible exposure, he recalled eating raw snake meat during military service roughly 50 years earlier. He received antiparasitic medication and was still well 45 days after surgery. 4

Sparganosis is caused by the larval stage of a Spirometra tapeworm. Humans can acquire it from undercooked snakes or frogs, contaminated water, or, less commonly, traditional poultices made from frog tissue. The clinical surprise here is the combination of extreme latency and an almost silent habitat: two large worms survived in the peritoneal cavity while the patient came to hospital for an unrelated operation.

A man in his 50s arrived after a high-speed eye injury. A 34-by-11-mm fragment from an electric cutter had entered through the nasal root and become completely buried in the frontal process of the zygomatic bone. He had been wearing protective glasses, yet the fragment was close enough to the orbit to make removal a vascular problem as well as an eye operation. 5

Preoperative cerebral angiography showed no ophthalmic-artery injury. Surgeons then used a lateral orbitotomy with Berke canthotomy and a controlled osteotomy to extract the metal. The eye was preserved. Vision worsened over time, but at one year the appearance was good and the globe remained intact. 5

The diagnostic lesson is physical rather than biochemical: a small change in the assumed path of an object can change the operation. Angiography established what the fragment had not damaged before the team decided how to take it out.

About 15 minutes after a general anaesthetic for elective dental extraction, a man in his 30s began having repeated bursts of retrocollis, axial hyperextension, and decorticate-like posturing in the recovery unit. The episodes came two or three times a minute and lasted several seconds. He stayed awake and fully oriented during them. 6

He had received 150 mg of propofol, or 1.88 mg/kg. Blood tests, metabolic studies, and head CT were normal. A 1-mg intravenous dose of lorazepam helped settle the movements, which disappeared within about an hour without haemodynamic instability or a residual neurological deficit. The history supplied the missing clue: he had experienced similar movements after propofol decades earlier and again during later propofol sedation. 6

Opisthotonos is a severe backward arching of the head and trunk. In this case, the timing, preserved awareness, and absence of a postictal state pointed away from epilepsy and toward a rare propofol-related excitatory or dystonic reaction. The patient was advised to avoid propofol; later endoscopy using midazolam-based sedation did not reproduce the event.

An elderly woman taking tacrolimus and corticosteroids for focal segmental glomerulosclerosis had three months of cough, fever, and weight loss. Imaging showed collapse of the right upper lobe. A bronchial lesion looked like an ulcerated, cold-abscess-like process, the sort of appearance that can pull the differential toward infection or malignancy. 7

Bronchoscopy found the stranger answer: a fragment of betel nut embedded in granulation tissue inside the lesion. There was no pus. The foreign body was removed endoscopically, and the patient recovered completely. 7

The immunosuppression mattered because it may have muted the inflammatory response that would normally make aspiration easier to recognise. A culture-specific or geographically familiar object can remain invisible in the history until bronchoscopy supplies the physical evidence.

A woman in her 60s had spent 18 months with secretory diarrhea, an 8-kg weight loss, repeated dehydration, and severe hypokalaemia. During one admission her potassium was 2.1 mmol/L. Earlier evaluations for infectious and inflammatory bowel disease, including colonoscopy, had not found the cause. 8

CT finally showed an 8-cm mass in the pancreatic tail. Biopsy identified a well-differentiated pancreatic neuroendocrine tumor, and the serum concentration of vasoactive intestinal peptide was eight times the upper limit of normal. That combination established a VIPoma, a tumor that drives intestinal secretion and can produce the pattern of watery diarrhea, potassium loss, and dehydration known as WDHA syndrome. 8

Long-acting somatostatin analogues were started and the primary tumor was removed. The diarrhea stopped and the hypokalaemia improved. The case is a reminder that a biochemical pattern can be more localising than the symptom that brought the patient to clinic: the intestine was loud, but the source was in the pancreas.

A man in his 40s developed a Miller Fisher/Guillain-Barré overlap syndrome with bilateral vocal-cord paralysis and respiratory failure. He required emergency intubation and then a tracheostomy. His peripheral neurological function later improved, but the vocal cords remained immobile, preventing decannulation. 9

Laryngeal electromyography showed denervation and reinnervation, suggesting that the nerve injury was recovering. The persistent obstruction therefore needed a second explanation. Surgery found type 1 Bogdasarian posterior glottic stenosis, a mechanical scar-related fixation that had followed intubation. CO2-laser scar excision, balloon dilation, and steroid injection improved the airway and allowed successful tracheostomy decannulation. 9

The first diagnosis was correct, but incomplete. The vocal cords had started as a neurological problem and ended as a mechanical one. Laryngeal electromyography made that handoff visible.

These reports are bizarre because the body kept offering the wrong-looking clue: a worm in an operation for a hernia, a blade near an eye, a seizure-like movement caused by an anaesthetic, a nut inside a bronchial lesion, a pancreatic hormone hidden behind diarrhea, and scar tissue left behind after a neuropathy. In each case, the useful question changed when clinicians stopped treating the unexpected finding as incidental.