Multidisciplinary management of a penetrating cerebellar injury by a fishing speargun: A case study and literature review

Oearsakul, Thakul; Kaewborisutsakul, Anukoon; Jantharapattana, Kitti; Khumtong, Rujimas; Puetpaiboon, Asamaporn; Sangthong, Burapat

doi:10.25259/sni_506_2021

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…e majority of studies are case reports or series in adult patients and the most frequent causes are occupational, assaults, or self-inflicted. [9,15,16,21,22,28,30,32] e civilian PTBI however differs extensively regarding the epidemiology, the underlying mechanisms, and outcomes between nations. In the US where having gunshot is legal, the majority of assaults are caused by GSW leading to a highvelocity PTBI.…”

Section: Discussionmentioning

confidence: 99%

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Civilian penetrating traumatic brain injury: A 5-year single-center experience

Yousefi¹,

Azami²,

Borazjani³

et al. 2023

Surgical Neurology International

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Background: The aim of this study was to report the demographics and clinical features of patients with penetrating traumatic brain injury (PTBI) during the past 5 years in Rajaee Hospital, a tertiary referral trauma center in Shiraz, southern Iran. Methods: We conducted a 5-year retrospective evaluation of all patients diagnosed with PTBI who were referred to Rajaee Hospital. We retrieved the following items from the hospital’s database and PACS system: patients’ demographics, on-admission Glasgow Coma Scale (GCS), presence of trauma to other organs, duration of the hospital and ICU stay, the neurosurgical interventions, any necessity of tracheostomy, duration of ventilator dependency, the entrance point of the trauma in the skull, type of assault, length of trajectory in the brain parenchyma, the number of remaining objects in the brain, the occurrence of any hemorrhagic phenomenon, the cross of the bullet from the midline or coronal suture, and the presence of the pneumocephalus. Results: A total of 59 patients with a mean age of 28.75 ± 9.40 had PTBI over the 5 years. The mortality rate was 8.5%. Stab wounds, shotguns, gunshots, and airguns were the cause of injury in 33 (56%), 14 (23.7%), 10 (17%), and 2 (3.4%) patients, respectively. The median initial GCS of patients was 15 (3–15). Intracranial hemorrhage was observed in 33 cases, subdural hematoma in 18 cases, intraventricular hemorrhage in eight cases, and subarachnoid hemorrhage in four cases. The mean duration of hospitalization was 10.05 ± 10.75 (ranging from 1 to 62 days). Furthermore, 43 patients experienced ICU admission with mean days of 6.5 ± 5.62 (1–23). The temporal and frontal regions were the most common entrance points, in 23 and 19 patients, respectively. Conclusion: The incidence of PTBI is relatively low in our center, possibly due to the prohibition of possession or using warm weapons in Iran. Further, multicenter studies with larger sample sizes are needed to determine prognostic factors associated with worse clinical outcomes after PTBI.

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Section: Discussionmentioning

confidence: 99%

“…The majority of studies are case reports or series in adult patients and the most frequent causes are occupational, assaults, or self-inflicted. [ 9 , 15 , 16 , 21 , 22 , 28 , 30 , 32 ]…”

Section: Discussionmentioning

confidence: 99%

Civilian penetrating traumatic brain injury: A 5-year single-center experience

Yousefi¹,

Azami²,

Borazjani³

et al. 2023

Surgical Neurology International

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“…But if the flapper is embedded at the base of the skull, the spear can be pulled in the retrograde direction without the risk of associated damage to the brain parenchyma. 1 In patients with associated vascular injury identified on CT angiography, or objects in-situ with a high risk of vascular injury, it would be advantageous to undertake the surgery in a hybrid OT where the multidisciplinary team is capable of performing endovascular evaluation and treatment along with surgery. Angiography can also be performed immediately after removal of the spear to determine any ongoing bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…pearfishing is a popular sport in New Zealand. While there have been a few self-inflicted speargun injuries causing fatal intracranial damage, [1][2][3][4] accidental speargun injuries while fishing are even less common. 5,6 These cases suggest that the trajectory of the spear and the extent of cranio-facial injuries are different between self-inflicted and unintentional injuries.…”

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confidence: 99%

A rare case of penetrating intra-abdominal trauma by a fishing speargun

Civil,

Pothiawala

2022

NZMJ

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introduction: Spearfishing is a popular sport in New Zealand. While there have been a few reported self-inflicted speargun injuries causing fatal intracranial damage, accidental speargun injuries while fishing are less common. Intra-abdominal speargun injuries are even less common. Its occurrence in a 30-year-old male patient reported here highlights the potential risk of life-threatening injuries.case report: A 30-year-old male sustained an accidental speargun injury, with the spear passing through central small bowel loops and its pointed tip penetrating the left iliac wing. The patient underwent laparotomy, and the spear was removed in an antegrade fashion with primary closure of small bowel enterotomies and repair of the mesenteric defects. He had a re-look laparotomy 48 hours later with resection and anastomosis of two primary small bowel repairs and was eventually discharged after 12 days. discussion: Information obtained by radiological evaluation using computed tomography (CT) scan and angiography regarding the spear trajectory, injured organs, vasculature and spear tip mechanism is important to decide the best surgical approach. The spear should be removed in an antegrade fashion, because pulling the spear in the retrograde direction can cause further tissue and/or vascular injury. Currently, there is no legislation regarding the use of spearguns and users do not require a license, despite the potential for severe penetrating trauma similar to that caused by firearms. conclusion: Spearguns can produce life-threatening injuries and the removal of the spear depends on the location of the tip in relation to adjacent structures and whether the flapper is open. It often requires a multidisciplinary team approach. Safety guidelines need to be published and widely available, and the potential risks of speargun injuries should be included in fishing rules. Introducing license requirement for possession and handling of this firearm-like weapon also needs to be considered.

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