Long-term management options for sea urchin injury: a case series

Abstract

In the UK, sea urchin-related injuries (SUIs) most commonly present in returning travellers. Delayed complications mainly affect the skin but nerves, tendons, joints and bones may also be involved. The management of chronic reactions may be challenging and a variety of approaches have been described. Surgical measures are often undertaken, particularly when retained spines are suspected. We demonstrate, through three cases presenting in the UK with chronic SUIs, that conservative management, surgery and intralesional corticosteroids may all be associated with satisfactory outcomes. Management options should consider the presence of retained spines, injury site, symptoms and importantly, patient preference.

Sea Urchin Injury Complicated by Lime Phototoxic Reaction

“…The SUI was appropriately treated by removal of the spines, 4 but the application of lime juice caused the skin changes seen in our patient. In nonmedical settings such as beach resorts, use of lime juice or other acidic substances to attempt to dissolve the spines is believed to be an effective method.…”

“…In nonmedical settings such as beach resorts, use of lime juice or other acidic substances to attempt to dissolve the spines is believed to be an effective method. Removal of the spines is crucial to prevent development of chronic granulomatous reactions, 4 but use of acidic substances such as lime juice should be avoided. Use of nonphotosensitizing antiseptic agents may be more appropriate.…”

Sea Urchin Spine Embedded in the Sole of the Foot: Eight-Year Radiographic Follow-Up Without Removal

“…As shown by our patient’s case, a sea urchin spine that is not embedded near-critical regions might not require surgical intervention. We suspect that in many cases, because symptoms from one or a few embedded sea urchin spine tips improve rather quickly, they are not removed and are ultimately deemed innocuous [ 31 , 58 ]. Similarly, in our patient, despite the presence of an embedded spine eight years after injury, he reported no pain or discomfort.…”

“…This is because the investigator reported that the embedded sea urchin spines were detected on plain or standard radiographs, though they were very faint. In cases such as these, radiographs with 'soft tissue windows' or with the capacity of other digital enhancements, or ultrasonography, are the next steps in the diagnostic imaging workup of sea urchin injuries [10,[28][29][30][31][32]. Computed tomography (CT) scanning in cases of deeply embedded spines can be more useful than plain radiography and is also superior to magnetic resonance (MR) imaging for detecting embedded sea urchin spines [10].…”