A hunting arrow traumatism to the head: a case report from NigerAssoumane Issa Ibrahim1,2, Roméo
Bujiriri Murhega1,2,3 , Sanoussi
Samuila1,21. Department of Neurosurgery, National Hospital of Niamey,
Niamey, Niger 2. Faculty of Health Sciences of the Abdou Moumouni University of
Niamey, Niger 3. Faculty of medicine, catholic university of Bukavu,
Democratic Republic of Congo Corresponding author : Roméo Bujiriri Murhega, quartier
Harobanda, ville de Niamey, Niger, +22782078866,romeobujiriri1@gmail.com, ORCID: 0000-0002- 0022-6355Key clinical message Arrow injuries have not disappeared in our environment
despite the advances in the development of warfare tools in the world.
All regions of the body can be the target of these arrows and in
particular the cephalic region whose gravity will depend on the
structures reached. Abstract With the development of modern weapons of war, arrow wounds have become
rare in developed countries, but they are still common in developing
countries, including Niger. These injuries are often serious and
life-threatening when they are in the head and neck region, due to the
presence of major vessels and vital organs in these areas of the body.
Extraction of these arrows is usually difficult due to the proximity of
major vital structures. Unskilled extraction can aggravate the injury or
result in unintentional damage to vital structures with imminent risk of
death. We present the case of a patient with a homemade arrow to the
head in the left periorbital region that we successfully extracted at
the National Hospital in Niamey. Our objective is to highlight the
experience with this patient and review some reports in the literature.Keywords: Arrow wounds, head wounds, NiameyIntroduction Since ancient times, since prehistoric times, arrows have been used as
weapons of war in many civilizations, including African
civilizations.1 With advances in technology, arrows as
weapons of war are now almost abandoned in developed countries.
Nevertheless, in developing countries, arrow injuries are still a
reality.1,2In developing countries, for example, penetrating head injuries occur
most often after fights and conflicts between farmers, and these
situations are much more frequent in practice than the rarity of
reported cases would suggest.2,3Arrow injuries are very rare.4,5 All areas of the body
can be targets, including the cephalic region, and the severity of which
depends on several factors. Among these factors, we cite, the distance
at which the arrow was shot, the degree of penetration of the arrow and
the application or not of poison on the arrowhead, which is a common
practice.1 These injuries can affect any part of the
human body, including the head and neck and can be
fatal.6 These head and neck injuries are often
life-threatening due to the presence of major vessels and vital organs.
Management of these injuries is not always easy due to the proximity of
major vital structures. We report on a patient who received a left
periorbital arrow and was successfully treated.Case Report A 42-year-old patient from a region far from Niamey (the Diffa region),
located 1,318.8 kilometers from the city of Niamey, was referred to the
surgical emergency room of the national hospital in Niamey five days
after a fight between farmers over agricultural land. On admission, he
presented with an impacted arrow in the left orbital rim 1 cm lateral to
the medial canthus (Figure 1). The patient was conscious,
without signs of intracranial hypertension or focal signs. His vision
was normal. The CT scan performed showed the extracranial path of the
arrow. It crossed the left orbital rim, the base of the nose to the
right external canthus without penetrating the cranium (Figure 2
). The patient had received antibiotics and tetanus prophylaxis. He
underwent wound exploration with arrow removal under general anesthesia(Figure 3). The arrow was approached through a left eyebrow
incision. Dissection was completed to the tip of the arrow, and the
arrow was gently removed. The patient did well after surgery, no
complications were recorded, and he was discharged 1 week after
admission. Postoperative follow-up has not noted any particularities to
date and the wound has healed well (Figure 4). Discussion Head injuries are a major global public health problem. These traumas
encompass a wide range of etiologies.7 Among these
etiologies we can mention, accidents on the public road, accidents at
work, sports, trauma by bullets, trauma by arrows etc.
Head injuries from arrows are too rare in developed countries, but in
developing countries they have not disappeared despite advances in the
field of tools of war. In developing countries, peasants still value
their agricultural land, which is a source of wealth and
economy.2 Nevertheless, conflicts between them are
frequent and are the source of fights that most often involve bladed
weapons, including arrows. In this work we report the case of a patient
suffering from an arrow trauma to the head after agricultural conflicts
in his village.
In the literature, very few cases are reported on head injuries by
arrow. The clinical manifestation of penetrating arrow injuries in the
head area depends on the structure affected and the severity of the
injury. The degree and severity of the injuries depend on the distance
at which the arrow was fired, the trajectory it followed, the degree of
penetration and the possible application of poisons to the tip of the
arrow.8 Poisoned arrows cause paralysis or severe
infection of the wound depending on the nature of the
poison.2,9 Poisoned arrows cause paralysis or severe
infection of the wound depending on the nature of the
poison.2 Brain and spinal cord injuries can lead to
paraplegia, quadriplegia, ventricular hemorrhage, or immediate
death.1 The good news is that our patient the path of
the arrow was exclusively extracranial and the large vessels were not
affected.
The emergency action to be taken will depend on the clinical condition
of the patient at admission. Patients whose injuries are immediately
life-threatening should be treated urgently, while those who are
clinically stable and have optimal hemodynamic status are examined
before the decision to explore is made.10,11 Our
patient was clinically stable and had received a complete and
unremarkable clinical examination.
CT scan is an essential examination for the lesion assessment of
patients with arrow trauma to the head.1It is usually
indicated in patients who are hemodynamically stable, which was the case
for our patient. The scanner is a non-invasive diagnostic tool that
determines the trajectory of the arrow and its relationship with vital
structures.12 An attempt at blind extraction can lead
to a serious disaster, especially if major vessels have been hit. Our
patient was able to perform the cranioencephalic CT scan which clearly
showed us the extracranial trajectory of the arrow.Conclusion Arrow wounds to the head have never disappeared in developing countries
despite advances in the manufacture of tools of war. Care is difficult
when noble structures are affected. The prognosis is life-threatening
when there is damage to the large vessels, especially in a context of
limited resources. The urgency of the emergency always depends on the
patient’s clinical condition at the time of admission to hospital.ACKNOWLEDGMENT NoneCONFLICTS OF INTEREST NoneAUTHOR CONTRIBUTIONS Assoumane Issa Ibrahim and Roméo Bujiriri Murhega have designed,
conceptualized the study, and written the first draft under the
supervision of Sanoussi Samuila .ETHICAL STATEMENT This case report received ethical clearance from the Ethical committee
of the university of the first author.CONSENT Written informed consent was signed by the patient prior to the
publication of this paperDATA AVAILABILITY STATEMENT All the materials used in this study are available on request.Bibliography 1. Abdullahi H, Adamu A, Hasheem MG. Penetrating Arrow Injuries of the
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