Surgeon’s Mysterious Abdominal Pain Linked to Grilled Meat

The Washington Post reported that Thomas P. Trezona, a retired surgical oncologist, faced a frightening possibility as he underwent a CT scan, fearing he might have pancreatic cancer, the same disease that claimed his mother’s life. The symptoms he experienced – violent abdominal pain, nausea, and rapid weight loss – pointed to a grim diagnosis. However, to his enormous relief, the scan revealed no sign of cancer. Instead, his internist suspected a reaction to grain in his diet, while blood tests hinted at a rare, chronic gastrointestinal disorder. 

Despite the initial inconclusive findings, Trezona’s persistent and systematic approach, developed over his long medical career, led him and his longtime gastroenterologist, Jonathan Gonenne, to discover the unusual cause of his alarming symptoms. After nearly two months, during which his health declined, the truth behind his debilitating condition finally surfaced. 

Trezona’s journey began on July 13, shortly after returning from a rafting trip in the Grand Canyon, when he started experiencing vague pain in his upper abdomen. As the pain worsened and he began feeling bloated and nauseous, he struggled to eat properly. Recognizing the seriousness of his symptoms, Trezona approached his illness with the mindset of a surgeon, constructing a differential diagnosis and keeping a daily symptom journal. 

Initially, he suspected an infectious disease caused by a parasite, but that theory was soon ruled out. With a family history of gastrointestinal malignancies and having watched his mother succumb to pancreatic cancer, Trezona feared the worst. Unable to secure an earlier appointment with his internist, he contacted Gonenne, hoping for assistance. 

A week before his scheduled CT scan, Trezona experienced excruciating pain that led him to the emergency room. Tests revealed an elevated eosinophil count, which indicated various possibilities, including allergies, parasitic infections, or cancer. However, given his condition, it was essential to identify the cause immediately. 

Trezona saw his primary care doctor the following week, who suggested a grain-free diet as a potential remedy. Although skeptical, Trezona followed the advice but found no relief. As his condition worsened, and he lost over 15 pounds in less than a month, the pain became unbearable. Gonenne was equally baffled, having ruled out eosinophilic gastroenteritis through an endoscopy. 

Seeking advice from the Mayo Clinic, Gonenne considered the possibility of a CT enterography to inspect the small intestine further. However, he opted for an MRI enterography instead, which ultimately led to an unexpected revelation. Shortly before the MRI, Trezona’s pain miraculously subsided in late August, and he almost canceled the appointment. 

The radiologist spotted an unidentified metal “artifact” in Trezona’s left upper abdomen during the MRI. This discovery puzzled everyone, as it could not be linked to any previous procedure or medical condition. After comparing the CT and MRI scans, the metal abnormality was determined to be visible in both, resembling a normal calcification on the artery wall. Further investigation revealed that the metal wire had moved slightly, leading to the discovery of a minor, calcified gallstone in Trezona’s gallbladder. However, the mystery remained: How did the wire end up in his abdomen, and where did it come from? 

Gonenne recalled a past patient who unknowingly swallowed a wire bristle from a metal brush used to clean barbecue grates, which led to similar symptoms. Realizing this could be the answer; he suspected that Trezona might have inadvertently ingested a wire from his grill brush, causing painful spasms that led to the rapid weight loss and subsequent gallstone. 

On September 13, a portion of abdominal tissue containing the two-centimeter-long wire was successfully extracted during the gallbladder removal surgery. Trezona, after his operation, compared the extracted wire to the one from his grill brush under a microscope, and they matched the carbon pattern. reported Trezona’s recovery was complete, but the experience left him shaken and empathetic toward his oncology patients’ struggles. He realized the severity of undiagnosed pain and the desperation it can cause, even for an experienced surgeon like himself. 

Gonenne’s steadfast support and detailed approach to the case was instrumental in uncovering the truth. He emphasized the importance of personally reviewing scan images and primary data, especially in complex cases, and Trezona’s determination fueled the search for an answer. 

The case highlighted the underrecognized dangers posed by grill brush wires, which can cause severe injuries when accidentally ingested. Trezona hopes to raise awareness of this hazard, sparing others from similar ordeals. His story serves as a reminder of the significance of thorough investigations, meticulous attention to detail, and the power of determination in resolving challenging medical mysteries.