Diagnosis dilemma: a man stabbed through the base of the throat and skull – by a fish

Patient: 31-year-old man from Louisiana

Symptoms: When the patient arrived at the hospital, he was bleeding from his mouth, with severe neck pain and stiffness. When he looked into the man, he noticed that his doctor had shed tears behind his throat on his right side.

What happened next: A sports fisherman was brought to the hospital by boat and helicopter after an accident during a marine fishing trip. He caught a white merlin (Kajikia albida), a kind of large fish with a long pointy “bill” weighing about 60 pounds (27 kilograms). This species can grow up to 180 pounds (82 kg).

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As the man leaned against the side of the boat to release the hook from the fish, it jumped and slapped him in his mouth, causing the man to fall back onto the boat. He felt a pain in his neck, which radiated into his spine.

In the hospital, X-rays of the male superior spine did not reveal any abnormalities. However, his intense spinal pain and neck stiffness led one of his doctors to order a computed tomography (CT) scan of the same area. On the CT scan, the doctor noted that it was a “wedge-shaped hyperdence object,” they wrote in their report of the incident. The object entered the back of the man’s throat and entered the spinal canal. It stuck there and thrusts a foramen magnum – a large hole at the base of the skull through which the spinal cord passes.

Diagnosis: The doctor immediately performed surgery on the man to remove the penetrating material. They administered general anesthesia and the surgeon used an absorber (an instrument that kept the wound open) to expose the object that turned out to be a broken tip of the fish method.

Treatment: The sharp bill fragment was tightly pinched in the male skull, so the surgeon had to make an additional incision above the male’s top vertebra to remove it and pulled along the path of invasion. Measured approximately 1.4 inches (3.5 cm) in length.

After removing the fragments, the patient was given five antibiotics to prevent infection from the microorganisms found in the throat and from bacteria endemic to the marine environment. He was discharged eight days later and continued to take multiple antibiotics for the next two weeks.

On his final follow-up visit, the man recovered completely and showed no prolonged neurological symptoms.

What makes the case unique: In 1848, doctors published their first medical case study on skull injuries caused by foreign bodies. An explosion of gunpowder sent iron bars into the skull of railroad workers Phineas Gauge. Gage recovered, but he showed a change in personality caused by his doctors’ serious brain damage.

In another notable case published in 1895, a man stumbled and slayed his face first to the oil gas. The spout penetrated his cheeks and stuck at the base of his skull, causing temporary incontinence and permanent memory loss.

Since these 19th century cases, doctors have reported cases of skull trauma in various parts of the skull, from various objects, including crochet hooks, pitchforks, bicycle keys, and harpoons.

The man’s case is the first reported case of significant borehole damage, similar to the first damage caused by the fish bill, according to the report.