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

KP Singaravelu; Vinay R Pandit; Ramaprakasha Saya; V Nagasubramanyam

doi:10.4103/JDRNTRUHS.JDRNTRUHS_86_17

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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

KP Singaravelu¹, Vinay R Pandit¹, Ramaprakasha Saya², V Nagasubramanyam¹
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 Publication

10-Jan-2019

Correspondence Address:
Dr. V Nagasubramanyam
Department of Emergency Medicine and Trauma, JIPMER, Pondicherry - 605 006
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_86_17

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 2023 Mar 27];7:285-7. Available from: https://www.jdrntruhs.org/text.asp?2018/7/4/285/249835

Introduction

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

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 4^th and 5^th 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 4^th and 5^th ribs, without any underlying lung parenchymal injury [Figure 2].

Figure 1: (a) 8 × 3 cms muscle deep laceration in the right 4^th and 5^th 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 4^th and 5^th 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 6^th 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

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.

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