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CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 4  |  Page : 285-287

Unusual cause of chest trauma: Case report of wild boar attack


1 Department of Emergency Medicine and Trauma, JIPMER, Pondicherry, India
2 Department of General Medicine, Kanchuru Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India

Date of Web Publication10-Jan-2019

Correspondence Address:
Dr. V Nagasubramanyam
Department of Emergency Medicine and Trauma, JIPMER, Pondicherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_86_17

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  Abstract 


Boar attack to human is uncommon in India and rarely seen in emergency departments. The usual site of injury in such attacks is lower limbs. We report a case of a wild boar attack with penetrating chest injury.

Keywords: Boar attack, penetrating thoracic injury, pneumothorax


How to cite this article:
Singaravelu K P, Pandit VR, Saya R, Nagasubramanyam V. Unusual cause of chest trauma: Case report of wild boar attack. J NTR Univ Health Sci 2018;7:285-7

How to cite this URL:
Singaravelu K P, Pandit VR, Saya R, Nagasubramanyam V. Unusual cause of chest trauma: Case report of wild boar attack. J NTR Univ Health Sci [serial online] 2018 [cited 2019 Jul 21];7:285-7. Available from: http://www.jdrntruhs.org/text.asp?2018/7/4/285/249835




  Introduction Top


Wild boar attacks are underreported in medical literature. In India, wild boars are seen in the deep forest and agricultural areas. Wild boar attacks on humans are rare, mostly limited to lower limbs; primary attack to the chest has not been reported. When provoked, boars are known to attack repeatedly with their sharp tusks, resulting in penetrating injuries.[1] Here, we report a case of a very unusual incident in which a boar attack with tusk resulted in penetrating thoracic injury with pneumothorax.


  Case Report Top


A 28-year-old man presented to the Emergency Room 5 hours following the animal attack (boar) to the right side of the chest. He was complaining of right-sided chest pain and breathing difficulty. On arrival, he was conscious; his vitals were: heart rate – 96/min, respiratory rate – 26/min, blood pressure – 110/70 mm Hg, and SPO2–90% room air. He was triaged as Emergency Severity Index level 2. Local examination revealed 8 × 3 cm muscle deep laceration in the right 4th and 5th intercostal space [Figure 1]a subcutaneous emphysema; breath sounds were diminished on the right side. Along with the resuscitative measures, extended focused abdominal sonography in trauma (eFAST) revealed right-sided pneumothorax. Chest X-ray showed blunting of the right cardiophrenic angle [Figure 1]b. Computed tomography (CT) of the chest suggested right-sided pneumothorax, and three-dimensional reconstructed image on CT revealed underlying fracture of right 4th and 5th ribs, without any underlying lung parenchymal injury [Figure 2].
Figure 1: (a) 8 × 3 cms muscle deep laceration in the right 4th and 5th intercostal space. (b) Chest x-ray showing blunting of right cardio-phrenic angle, no obvious pneumothorax and rib fracture seen

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Figure 2: (a) Computed Tomography (CT) of chest suggested right sided pneumothorax. (b) 3D reconstructed image on CT showing underlying fracture of right 4th and 5th ribs

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The cardiothoracic surgeon was consulted, and after thorough wound wash with sodium chloride 0.9%, wound was closed in two layers; muscle with vicryl and skin with prolene. Right side intercostal tube was placed in the 6th intercostal space. Cefazolin 1 g intravenous and metronidazole 500 mg intravenous along with anti-rabies vaccine and tetanus prophylaxis were administered in the emergency room. The patient was hospitalized for continuity of care under cardiothoracic surgery and course in the hospital was uneventful. He was discharged on day 6 after removal of the intercostal tube. He was advised to continue the full course of human cell diploid (anti-rabies) vaccine at discharge.


  Discussion Top


Wild boars are habitants of dark plantation and grasslands areas. They can grow up to 6 feet and weigh up to 90 kg. Most common site of injury in humans is reported in the posterior aspect of the thigh and leg.[2] Male boar has a sharp tusk that can cause deep penetrating injuries resulting in serious infections.[3] Death is reported with thigh injury causing hemorrhagic shock.[4] Fatal cases were reported with abdominal injury[5] and craniocerebral injury[6] from wild boar attack.

Unlike the injuries inflicted by wild cats, canines, and bulls, the hallmark of boar attack is the infliction of multiple penetrating injuries to the lower part of the body. Most common organism isolated with pig injuries are Bacteroides species,  Escherichia More Details coli, Pasteurella aerogenes, P. multocida, Proteus species, Staphylococcus aureus, Staphylococcus species, Streptococcus agalactiae, and S. dysgalactiae.[7] Boars with rabies virus infection are reported, but so far transmission to humans is not reported.[8] The decision to close the wound primarily should be taken case by case. Antibiotic prophylaxis should be given as and when indicated, especially when primary closure of the wound is done.[9] Tetanus toxoid booster with or without immunoglobulin should be given as per the immunization status and recommendations.[10]

Penetrating thoracic injury with occult pneumothorax can be easily missed by chest X-ray. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest with or without rib fractures, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall, resulting in subcutaneous emphysema. In this case, chest X-ray was inconclusive to detect the underlying injuries; eFAST and CT detected the underlying pneumothorax and rib fractures.

In conclusion, wild boar attacks presenting with life threatening organ injuries require early identification and prompt and aggressive management. Tetanus prophylaxis, anti-rabies vaccine, and broad-spectrum antibiotic coverage reduce the infection and improve the outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gunduz A, Turedi S, Nuhoglu I, Kalkan A, Turkmen SS. Wild Boar Attacks. Wilderness Environ Med 2007;18:117-9.  Back to cited text no. 1
    
2.
Kose O, Guler F, Baz AB, Akalın S, Turan A. Management of a Wild Boar Wound: A Case Report. Wilderness Environ Med 2011;22:242-5.  Back to cited text no. 2
    
3.
Van Demark RE Sr, Van Demark RE Jr. Swine bites of the hand. J Hand Surg Am 1991;16:136-8.  Back to cited text no. 3
    
4.
Tumram NK, Dhawne SG, Ambade VN, Dixit PG. Fatal tusk injuries from a wild boar attack. Med Leg J 2015;83:54-6.  Back to cited text no. 4
    
5.
Shetty M, Menezes R, Kanchan T, Shetty B, Chauhan A. Fatal Craniocerebral Injury from Wild Boar Attack. Wilderness Environ Med 2008;19:222.  Back to cited text no. 5
    
6.
Manipady S, Menezes RG, Bastia BK. Death by attack from a wild boar. J Clin Forensic Med 2006;13:89-91.  Back to cited text no. 6
    
7.
Abrahamian FM, Goldstein EJ. Microbiology of Animal Bite Wound Infections. Clin Microbiol Rev 2011;24:231-46.  Back to cited text no. 7
    
8.
DuVernoy TS, Mitchell KC, Myers RA, Walinski LW, Tinsley MO. The First Laboratory-confirmed Rabid Pig in Maryland, 2003. Zoonoses Public Health 2008;55:431-5.  Back to cited text no. 8
    
9.
Morgan M, Palmer J. Dog bites. BMJ 2007;24;334:413-7.  Back to cited text no. 9
    
10.
Brook I. Management of human and animal bite wound infection: An overview. Curr Infect Dis Rep 2009;11:389-95.  Back to cited text no. 10
    


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