The case of the deadly Santol Seed

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Unecessary and premature death

EAT the fruit but don't swallow the seeds unless you want to get into trouble.

The Department of Surgery of the Ospital ng Maynila Medical Center (OMMC) headed by Dr. Reynaldo Joson once again issued an advisory to warn the public on the hazards of swallowing santol seeds.

Santol is a seasonal tropical fruit with seeds half the size of chestnuts.

"We strongly advise the public not to swallow santol seeds because they can cause unnecessary and premature death," warns Dr. Joson.

Dr. Joson reports that a 47-year-old female vendor died recently as a result of complication of swallowed santol seeds. She ate about 10 Bangkok santols and swallowed all the seeds, about 30 to 40 of them. Three to four days later, she went to the OMMC because of severe abdominal pain that could not be relieved by medicines.

She had excruciating pain all over the abdomen when palpated by the physician. With a diagnosis of perforated intestines secondary to the swallowed seeds, an operation was immediately performed. Upon opening the abdomen, feces were seen spilled all over the abdominal cavity, leaking out from three perforations in the large intestines.

The perforations were caused by the sharp ends of the santol seeds.

Surgeons had to remove the segment of the large intestine with the perforations, and make a colostomy, which is an artificial anus on the abdominal wall. They spent a lot of time cleaning the abdominal cavity to remove the feces.

The surgeons tried their best to save the patient but on the fourth day, the patient died of uncontrollable and irreversible infection in the blood stream, called septicemia.

"Most of the time, the seeds will be passed through the anus during bowel movement," Dr. Joson explains.

"However, in some cases the seeds may cause intestinal obstruction by sticking together to form a hard bolus of seeds or by completely plugging the intestinal lumen that has been previously and partially constricted by a disease like a tumor or tuberculosis."

He adds that the seeds may also cause perforation of the intestines. After the fibers enveloping the seed have been digested, the remaining shell, which is indigestible, is usually sharp at its two ends. These sharp ends can perforate a normal intestinal wall especially if it has been weakened by a disease or a degenerative condition, such as repeated inflammation or diverticulosis of the intestines.

The resulting perforation will result in a spillage of feces into the abdominal cavity causing peritonitis, which is a serious infection of the lining of the abdomen and the entire abdominal cavity. If surgery is not done promptly, the infection can get into the bloodstream and this may lead to death.

Intestinal obstruction and perforation caused by swallowed santol seeds require resection-anastomosis surgery, which consists of cutting out and discarding the damaged parts of the intestines and reconnecting the cut ends together. Occasionally, the surgeon may do a colostomy.

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