In a recent case report, doctors have detailed what might be the world’s most horrific sneeze ever documented. Their patient, a 63-year-old man, sneezed out his intestines through his reopened surgical wounds. Remarkably, surgeons were able to carefully put the man’s bowels back where they belonged and the man made a complete recovery.

This article contains graphic descriptions that some readers might find upsetting. 

The case of the gut-busting sneeze was described in a paper published this May in the American Journal of Medical Case Reports. According to the report, the man had received surgery two weeks earlier that removed his bladder to treat the complications of previous radiation therapy for his prostate cancer. The surgery went off without a hitch, and that morning his doctors removed the staples covering his seemingly well-healed wounds. To celebrate, the man and his wife went to eat breakfast at a diner, and that’s when it happened.

The man let out a forceful sneeze while coughing and immediately after felt a “wet” sensation and pain in his lower abdomen. When he looked down, he saw “several loops of pink bowel” sticking out of his surgical wounds. To put it lightly, the man wasn’t exactly sure of what to do next. He covered his intestines with his shirt and initially thought about driving to the hospital himself. Worried that this might worsen his predicament, though, his wife instead called for an ambulance.

Unsurprisingly, the paramedic who arrived was likewise uncertain about the best way to handle the situation at first. She briefly considered pushing some of the bowels inside at first, but then remembered some lessons she had learned from lectures on treating similar injuries. The paramedic ultimately decided to cover the man’s exposed guts with an abdominal pad soaked in saline and gauze wrapped around the man’s body before taking him to the hospital.

Amazingly, his bowels remained intact throughout all this and he was otherwise doing well by the time he arrived at the emergency room. Three surgeons worked together to carefully maneuver the man’s intestines into its usual position. His recovery went smoothly and he was discharged six days later in good condition. His final diagnosis: a literal case of evisceration, also known as disembowelment. 

A reopened wound is an uncommon but known complication of bladder removal surgery. But it’s fair to say that this particular kind of incident is rare. The doctors looked through the medical literature and only identified seven similar cases of people losing their bowels through their reopened wounds. While the sneeze may have been the start of the man’s trouble, it’s likely that the coughing was the precipitating cause, the doctors wrote, since coughing can forcefully raise the air pressure within the abdomen. 

Though the man’s gut-spilling ordeal had a happy ending, the case does demonstrate that even trained medical professionals can have a rough time knowing how best to navigate these kinds of emergencies. So the doctors hope their write-up can help others, particularly patients and first responders, in the future. EMS directors might want to educate their staff about these cases using guidelines borrowed from treating similar injuries in combat, for instance, which include controlling people’s bleeding, rinsing the bowels with sterile saline, and keeping bowels covered with a moistened, sterile dressing.

Just in case you’re wondering, by the way, the doctors thankfully did not include a picture of the man’s injury. But they did think to create an illustration that anyone’s mother would be proud to put on their fridge.