The olfactory examination: a waft of disease.

Our discussion regarding the clinical use of smell evolved from a conversation about a surgical patient, who had a gunshot wound to the abdomen. During initial surgery, an injury to the splenic flexure of the colon was found and repaired. Postoperatively the patient didn’t improve as expected, and a missed injury was suspected. He was taken for a second laparotomy. On opening the abdomen, the foul, overpowering stench of faecal contamination of the peritoneal cavity led us to search for a missed bowel injury – which was found. After repairing this, we washed out the abdomen, and as the smell of faeces dissipated, the unmistakable smell of urine arose – the kind of strong odour smelled in a public toilet. So we searched for, and found, a missed ureteric injury.