Surprised doctors find 10-inch worm in man’s groin during elective surgery

医生在择期手术中惊现患者腹股沟内有 10 英寸长寄生虫

When surgeons dug into a man’s groin to repair a painless bulge, they made the unexpected discovery of a living, 10-inch-long (26 cm) worm snug in his abdomen. Adding to the oddity, the man told the surgeons that this had actually happened to him before, according to a case report in the New England Journal of Medicine. 当外科医生切开一名男子的腹股沟以修复一个无痛性肿块时，他们意外地发现其腹部内竟藏着一条活生生的、长达 10 英寸（26 厘米）的蠕虫。据《新英格兰医学杂志》的一份病例报告显示，更令人称奇的是，该男子告诉医生，这种情况以前也发生过。

The 71-year-old man had opted to have surgery to repair the bulge, which was an inguinal hernia. These types of protrusions are fairly common, particularly in older men, and occur when a small amount of abdominal contents, such as fat or a bit of intestines, slips through a gap or weak point in the muscles and tissues of the abdominal wall. 这名 71 岁的男子选择接受手术来修复这个肿块，即腹股沟疝。这类突起在老年男性中相当常见，通常是由于少量腹腔内容物（如脂肪或部分肠道）通过腹壁肌肉和组织的缝隙或薄弱点滑出所致。

This bodily leakage creates an external bulge that, in some cases, can be painful and uncomfortable. If the bulge’s contents become stuck and pinched off, it can even create a life-threatening situation called a strangulated hernia. But, in other cases, the escaped innards are painless and loose and can be temporarily put back in place by simple, gentle massage. 这种身体组织的“渗漏”会形成外部肿块，在某些情况下会引起疼痛和不适。如果肿块内容物被卡住并受到挤压，甚至可能引发危及生命的“嵌顿疝”。但在其他情况下，滑出的内脏可能无痛且松动，通过简单的轻柔按摩即可暂时复位。

Most people with inguinal hernias will need surgery at some point to patch up their weak abdominal wall. But, for older men with no pain or discomfort, doctors may suggest watchful waiting, delaying surgery until the need is clear. This was the case for the man. But he elected to repair the inguinal hernia, which was on his right side. 大多数腹股沟疝患者最终都需要手术来修补薄弱的腹壁。但对于没有疼痛或不适的老年男性，医生可能会建议“观察等待”，推迟手术直到必要时再进行。这名男子的情况正是如此，但他最终还是选择了修复右侧的腹股沟疝。

Surgeons noted that the man appeared in good health before the surgery, reporting no symptoms besides the painless protrusion. His blood work likewise appeared normal, giving no indications of anything amiss, such as an elevated white blood cell count that might signal a parasitic infection. 外科医生指出，该男子在术前身体状况良好，除无痛性肿块外无其他症状。他的血液检查结果也显示正常，没有任何异常迹象（例如白细胞计数升高），无法预示可能存在的寄生虫感染。

Surgeons opted for a laparoscopic procedure, making small incisions to insert tools to fortify the abdominal wall. As they worked, they noticed something whitish and stringy. It was wedged between his bladder and pubic bone. The surgeons used forceps to grab at a loop that was poking into view and then needed multiple tugs to gently slide out the rest. 医生选择了腹腔镜手术，通过小切口插入器械来加固腹壁。在手术过程中，他们注意到了一些白色的丝状物，它被卡在膀胱和耻骨之间。医生用镊子夹住露出的部分，经过多次拉扯，才将其余部分轻轻取出。

When they carefully pulled it out in its entirety and unfurled it, they recognized it as a 26 cm-long (10.2 inch) tapeworm. It was still alive, and slithered and squirmed on the surgical table. 当他们小心翼翼地将其完整取出并展开时，确认这是一条长 26 厘米（10.2 英寸）的绦虫。它当时还活着，在手术台上蠕动扭曲。

Wandering worms

游走的蠕虫

After the surgery, a genetic test identified the worm as Spirometra erinaceieuropaei, which causes a tapeworm infection called sparganosis. These worms can be found in animals worldwide but are generally rare in humans. Their lifecycle is relatively complicated. Adult worms parasitize dogs and cats, which shed eggs in their feces. 术后基因检测证实该蠕虫为曼氏迭宫绦虫（Spirometra erinaceieuropaei），它会导致一种称为裂头蚴病的绦虫感染。这些蠕虫在世界各地的动物中都有发现，但在人类中较为罕见。它们的生命周期相当复杂：成虫寄生在猫狗体内，随粪便排出虫卵。

The eggs hatch in water, and the larvae are taken up by small crustaceans (copepods), the first intermediate host. The larvae develop and move into their second intermediate host—fish, amphibians, and reptiles—that eat the crustaceans. Normally, the larvae would complete their lifecycle when a cat or dog eats an infected second intermediate host. 虫卵在水中孵化，幼虫被小型甲壳类动物（剑水蚤）摄入，成为第一中间宿主。幼虫发育后进入第二中间宿主——捕食这些甲壳类动物的鱼类、两栖动物和爬行动物。通常情况下，当猫或狗吃掉受感染的第二中间宿主时，幼虫便会完成其生命周期。

But humans disrupt the cycle by picking up eggs in contaminated water or eating undercooked fish, reptiles, or amphibians. Humans aren’t a definitive host for the worms, and they become destined to aimlessly wander through our meat sacks. In rare instances, they can mature in the intestines and spew out eggs to complete their lifecycle. But most often, they migrate around and nestle elsewhere. 但人类通过接触受污染的水或食用未煮熟的鱼类、爬行动物或两栖动物，打断了这一循环。人类并非该蠕虫的终宿主，因此它们注定会在我们的体内漫无目的地游走。在极少数情况下，它们可能在肠道内成熟并排出虫卵以完成生命周期，但更多时候，它们会在体内迁移并寄生在其他部位。

They can be found almost anywhere in the body. Their movement is generally painless, but symptoms of the infection vary widely based on where they decide to settle. If it’s in the brain or spine, it can cause a range of neurological symptoms, for instance. In the man’s case, the worm’s final destination was apparently his abdominal cavity. 它们几乎可以出现在身体的任何部位。它们的移动通常是无痛的，但感染症状会根据其寄生位置的不同而有很大差异。例如，如果寄生在脑部或脊柱，可能会引起一系列神经系统症状。就这名男子而言，蠕虫的最终目的地显然是他的腹腔。

Oddly, the man told doctors that this wasn’t the first worm that had been pulled from his abdomen. Four years prior to his surgery for his right-side inguinal hernia, he had undergone surgery for a left-side inguinal hernia. In that procedure, surgeons had incidentally come upon another worm, which was 18 cm (7 inches). For unexplained reasons, the worm was not identified, and he was not treated with anti-parasitic drugs after the discovery. 奇怪的是，该男子告诉医生，这已经不是第一次从他腹部取出蠕虫了。在他进行右侧腹股沟疝手术的四年前，他曾接受过左侧腹股沟疝手术。在那次手术中，医生也偶然发现了一条 18 厘米（7 英寸）长的蠕虫。由于不明原因，当时并未对该蠕虫进行鉴定，他在发现后也未接受抗寄生虫药物治疗。

After this second surgery and worm discovery, his doctors put him on anti-parasitic medication to kill off any possible remaining worms lurking in him. They also tried to figure out how the worms got there in the first place. The man’s only recollection of a possible exposure was eating raw snake meat during military service 50 years prior. While Spirometra are known to have long lives in humans, the lifespan is typically reported as being around 20 to 30 years. 在第二次手术并发现蠕虫后，医生为他开了抗寄生虫药物，以杀灭体内可能残留的任何蠕虫。他们还试图查明这些蠕虫最初是如何进入他体内的。该男子唯一能回忆起的可能接触途径是 50 年前服兵役时曾食用过生蛇肉。虽然已知曼氏迭宫绦虫在人体内寿命较长，但通常报道的寿命约为 20 到 30 年。