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

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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.
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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.
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