Publications

Abstract

Bear attacks on humans are rare and are even more rarely reported in medical literature. Each year people have numerous accidental interactions with bears around the world. In India, bear attack incidences have been reported in and around Kashmir and in Central India. A very small fraction of these bear attacks result in human injury. Injuries due to bear attacks include skin lacerations, bites etc. The most common areas of injury are the face, legs and hands. Thoracic injuries due to a bear attack hasn't been reported earlier. We present the case of a 55 year old with bear attack, suffered among other injuries, a right Hemo-Pneumothorax. A flail segment was also noted on the right anterolateral region. The patient did not need any invasive ventilation. Right Inter-costal Drain tube inserted ICD drain was discontinued on day 4 of admission. Post drain removal a subcutaneous collection was noted on the back with suspicious pleural tear near the 12th rib detected on MRI. ICD was re-inserted and the patient, conservatively managed. Bear attacks are rare in India, and thoracic injuries causing a flail segment, pleural tear and a hemo-pneumothorax hasn't yet been reported. This case report hence, highlights the fact that bear attacks, like a blunt/penetrating trauma can provide with a challenging scenario in the emergency room. Right knowledge and stepwise management of these cases can therefore ensure complete and wholesome treatment, even in cases with thoracic injuries.

INTRODUCTION

Bear attacks on humans are rare and are even more rarely reported in medical literature. Each year, people have numerous accidental interactions with bears around the world. In India, bear attack incidences have been reported in and around Kashmir and in Central India. A very small fraction of these bear attacks result in human injury. The chance of a human encountering a bear increases as the remote bear territory diminishes. A search of scientific literature reveals very few articles detailing case reports or an in-depth analysis of injuries due to bear mauling. Here, we discuss the presentation and subsequent management of a 55-year-old male who came to us with chest wall and thoracic injuries after being mauled by a bear.

CASE REPORT

A 55-year-old male hailing from Anantapur presented with a history of being mauled by a bear in the early hours of the morning while in the fields. The patient claimed that there were three bears probably mother bear and her cubs and the attack was unprovoked. It started with the bear attacking him and causing numerous lacerations on the back and the right shoulder regions. The patient then “played dead” and the bear walked ahead; however, our patient woke up a tad bit earlier and caused the bear to come back and maul him again. The patient then had a brief loss of consciousness.

He was taken to a nearby clinic and was resuscitated with intravenous fluids. Hemopneumothorax was seen on the right side, right intercostal drain tube was inserted, and he was then referred to our center. The patient on arrival was alert, conscious, and oriented (Glasgow Coma Scale of 15/15) and with peripheral oxygen saturation of 90% at room air and 100% with 4 l/h of O2. He had multiple abrasions on the back and the right clavicular and shoulder areas with deep lacerations in the right deltoid region and another one in the right scapular area. A flail segment was noted on the right side in the anterolateral region. The patient was monitored in the intensive unit and then was shifted to the ward. The patient did not need any invasive ventilation. The wounds were thoroughly washed and secondarily sutured. Abrasions were dressed regularly, and collagen dressing was applied given the large area of abrasions spanning the entire back region. X-ray of the chest [Figure 1] revealed multiple rib fractures and an Inter-costal Drainage tube (ICD) in situ on the right side.