Delayed death after hyena bite in a 3-year-old Tanzanian boy: the unique reality of neurosurgery in a resource-limited setting

View More View Less
  • 1 Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania;
  • 2 Hospital General de Catalunya, Barcelona, Spain;
  • 3 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
  • 4 Weill Cornell Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

A 3-year-old boy presented after a hyena bite to the skull in Tanzania. A large degloving wound with herniating cerebrum was seen in the right parietotemporal region. A CT scan confirmed a large 8-cm skull defect. The patient was taken for irrigation and debridement, but due to significant tissue loss, the skin could not be closed. CSF leaked from the wound, and two additional operations for attempted closure were undertaken but failed. The plastic surgery team was consulted, but no closure was done because of the procedure’s complexity, lack of resources, and cost. CSF diversion could not be performed due to no available lumbar catheter or external ventricular drain. Meningitis developed, leading to severe hyponatremia and death. The current case highlights both the unique mechanism of a hyena bite requiring neurosurgical intervention and the realities of practicing neurosurgery in a low-resource setting.

ABBREVIATIONS EVD = external ventricular drain; LMIC = low- and middle-income country; MOI = Muhimbili Orthopaedic Institute; POD = postoperative day; VP = ventriculoperitoneal.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Scott L. Zuckerman: Vanderbilt University Medical Center, Nashville, TN. scott.zuckerman@vumc.org.

INCLUDE WHEN CITING Published online February 28, 2020; DOI: 10.3171/2019.12.PEDS19495.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Atreya A, Kanchan T, Nepal S, Acharya J: Brown bear attacks in a Nepalese scenario: a brief review. Wilderness Environ Med 26:587588, 2015

    • Search Google Scholar
    • Export Citation
  • 2

    Chum M, Ng WP: Traumatic tiger attack. J Neurosurg Pediatr 8:530534, 2011

  • 3

    Clark M, Adcock L: Honey for Wound Management: A Review of Clinical Effectiveness and Guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2018 (https://www.ncbi.nlm.nih.gov/books/NBK538361/) [Accessed January 16, 2020]

    • Search Google Scholar
    • Export Citation
  • 4

    Dabdoub CF, Dabdoub CB, Chavez M, Molina F: Survival of child after lion attack. Surg Neurol Int 4:77, 2013

  • 5

    Emami P, Kaiser TM, Regelsberger J, Goebell E, Fiehler J, Westphal M, : Case report: surviving a tiger attack. Neurosurg Rev 35:621624, 2012

    • Search Google Scholar
    • Export Citation
  • 6

    Fell MJ, Ayalew Y, McClenaghan FC, McGurk M: Facial injuries following hyena attack in rural eastern Ethiopia. Int J Oral Maxillofac Surg 43:14591464, 2014

    • Search Google Scholar
    • Export Citation
  • 7

    Gilyoma JM, Mabula JB, Chalya PL: Animal-related injuries in a resource-limited setting: experiences from a tertiary health institution in northwestern Tanzania. World J Emerg Surg 8:7, 2013

    • Search Google Scholar
    • Export Citation
  • 8

    Kumar R, Deleyiannis FW, Wilkinson C, O’Neill BR: Neurosurgical sequelae of domestic dog attacks in children. J Neurosurg Pediatr 19:2431, 2017

    • Search Google Scholar
    • Export Citation
  • 9

    Lavee I, Najjar R, Ben-Meir P, Sela E, Kassif Y, Emodi O, : Hyena attack of a child’s head and face: plastic reconstructive surgery challenge. Isr Med Assoc J 19:123124, 2017

    • Search Google Scholar
    • Export Citation
  • 10

    Mitchell KB, Kotecha VR, Chandika A: Bush animal attacks: management of complex injuries in a resource-limited setting. World J Emerg Surg 6:43, 2011

    • Search Google Scholar
    • Export Citation
  • 11

    Patil SB, Mody NB, Kale SM, Ingole SD: A review of 48 patients after bear attacks in Central India: demographics, management and outcomes. Indian J Plast Surg 48:6065, 2015

    • Search Google Scholar
    • Export Citation
  • 12

    Prasad SC, Thada ND, Rao P, Thada SR, Prasad KC: Grievous temporal and occipital injury caused by a bear attack. Case Rep Otolaryngol 2013:957251, 2013

    • Search Google Scholar
    • Export Citation
  • 13

    Steen T, Ravin K, Timmons S, Kershenovich A: Intracranial injuries from dog bites in children. Pediatr Neurosurg 50:187195, 2015

Metrics

All Time Past Year Past 30 Days
Abstract Views 88 88 82
Full Text Views 46 46 45
PDF Downloads 93 93 90
EPUB Downloads 0 0 0