An unusual, life-threatening camel bite to the abdomen of a young man

Camel-related major vascular injuries: A 20-years' experience

BACKGROUND

Majority of human animal-related injuries in the United Arab Emirates are caused by camels. These may involve major vessels and can be life-threatening. We aimed to study the biomechanism, injured regions, management, and outcome of major camel-related human vascular injuries.

METHODS

We retrospectively studied all patients who were admitted to Al-Ain Hospital with camel-related major vascular injury during January 2001 to January 2020. Studied variables included demography, mechanism of injury, injured structures, clinical presentation, vital signs on arrival, associated injuries, surgical management, ICU stay, length of hospital stay, complications, and outcome.

RESULTS

Seven patients were studied; all were males having a median age of 26 years. Five out of six bite injuries (83%) occured during the camel rutting season. The injuries were severe and life-threatening. A camel bite causes four small elliptical wounds of the canine teeth which resembles two stab wounds of 8 cm long, penetrating deeply and injuring major vessels. Four involved the carotid artery, one the femoral artery and vein, one the external iliac vein and one the aorta which was due to a fall from a camel. Although the standard of surgical care was high, the outcome was poor. Six patients were admitted to the ICU for a median of 5 days. One patient died, one became vegetative, and one had arm paralysis.

CONCLUSIONS

Major camel-related vascular injuries have a poor clinical outcome. This is related to the biomechanism of injury which combines penetrating, crushing and blunt trauma. Neck wounds of camel bites can be closed primarily after debridement.

Camel-Related Deaths-A Forensic Overview

ABSTRACT

Camels are ungulates of the genus Camelus and have been used for centuries in parts of Asia and Africa for transport and sustenance. Handling of camels is not without its dangers, and 4 cases from South Australia are reported with a review of lethal camel-related issues. Case 1 is a 56-year-old man who died of multiple blunt force injuries after he had attempted to move a 7-year-old female dromedary (Camelus dromedarius). Case 2 is a 65-year-old woman who was crushed by 1 or more camels that she had been training. Case 3 is a 1-year-old girl who died of blunt craniocerebral trauma after the car in which she was traveling rolled when the driver swerved to avoid a herd of camels that had strayed onto the road. Case 4 is a 66-year-old woman who died of ischemic and hypertensive cardiac disease exacerbated by physical activity while rounding up camels. Deaths associated with camels involve kicking, stomping, kneeling or sitting on a victim, or biting and shaking and throwing. Lethal mechanisms include hemorrhage from vascular injuries and internal organ disruption, crush asphyxia, and blunt craniospinal injuries. Death may also follow falls from camels or vehicle collisions. Camels also carry a wide range of zoonotic diseases, the most significant of which is Middle Eastern respiratory syndrome. Handling of camels may also exacerbate underlying organic illnesses such as cardiac disease. Those working with camels should be aware that the size, strength, and temperament of these animals may make them dangerous and that they also carry potentially lethal zoonotic diseases.

Camel Bite Associated with Depressed Skull Fracture with Rapidly Spreading Subgaleal Cellulitis

Camel bite represents a minimal proportion, and most of them are from the Middle East countries. Their infectious potential is poorly understood, and the guidelines for antimicrobial treatment are not well developed. We describe a 40-year-old male, who works as a camel herder and was bitten by a camel while he was tying it down which led to a unilateral depressed skull fracture and multiple bilateral teeth-puncture wounds in the scalp. He arrived to our emergency department 3 hours after injury. All the wounds were dry and the skin around them was healthy looking with no subcutaneous collections. CT scan of the head showed depressed skull fracture on the left temporal region. Within 12 hours, the patient developed spreading cellulitis in the scalp. This necessitated an urgent surgical intervention. The added challenge is the presence of a dural breach. Our patient presented a challenge at several levels. He presented early with clean puncture wounds that were treated according to the most agreed upon guidelines. But our novel finding of rapidly spreading cellulitis requires alteration of recommendation towards more aggressive therapeutic attitude including early surgical intervention, especially for those patients suspected of a dural tear with the depressed skull fracture, even if treated with appropriate antibiotics.