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.

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. 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.

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.

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. 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. 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. A picture of the surgical find is here.