Young Man With Fishing Injury
Article Outline
[Ann Emerg Med. 2009;54:854.]
A 23-year-old man presented to our trauma bay after sustaining a head injury while fishing. Emergency medical services reported that while fishing, the patient reeled in the sinker for what he thought may have been a fish and that the sinker suddenly flew through the air, striking him in the left eye (Figure 1).
Figure 1.
Left eye with entry wound in the superior medial aspect of the left orbit, with attached fishing line.
Diagnosis
Intracranial fishing line sinker. On presentation, he had a Glasgow Coma Scale score of 3, with shallow and agonal bleeding. He was immediately intubated as per advanced trauma life support protocol. A lateral skull radiograph was obtained and revealed a radiopaque teardrop density measuring 5 cm×1.6 cm and consistent with a bank lead surf casting sinker (Figure 2). A computed tomography scan of the head revealed effacement of the basilar cisterns, with midline shift from right to left, along with extensive intraparenchymal hemorrhage and early herniation. Although the left medial orbital wall was shattered, surprisingly, the globe was not ruptured. A neurosurgical consultation was obtained; however, it was determined that no surgical intervention was warranted according to the patient's overall clinical prognosis. He was treated to no avail and subsequently declared brain dead by the trauma service.
Figure 2.
Skull radiograph demonstrating intracranial fishing line sinker measuring 5 cm×1.6 cm. Used with permission of L.D. George Angus, MD, MPH, Nassau University Medical Center, East Meadow, NY.
Although fishing is a commonly enjoyed sport, most fishing injuries generally involve the fishhook, with the hands, skin, and fingers being the most commonly affected areas.1 Occasionally, the hook may embed itself in the eye or eyelid, and various techniques are described to deal with such injuries.2 Fishing line sinker injuries do occur and have resulted in fractures of the facial bones as well.3 As this case clearly demonstrates, the fishingline sinker can act in a manner similar to a low-velocity missile and, although an extremely rare event, can result in death from intracranial injuries. As in firearm injuries, the velocity of the sinker determines the severity of the injury.4 Although fishing is not generally considered to be a hazardous sport, a number of independent variables—velocity, angle, trajectory, weight, and shape of the sinker—can interact with pinpoint precision to produce devastating consequences. A change in any of those variables would undoubtedly have resulted in a different outcome.
References
- . Penetrating corneal fishhook injury. Ophthalmologica. 1994;208:112
- Removal of a fishhook in the eyelid and cornea using a vertical eyelid-splitting technique. Arch Ophthalmol. 1999;117:541–542
- An unusual penetrating facial injury due to a fishing-line sinker. J Oral Maxillofac Surg. 2001;59:945–947
- . Maxillofacial trauma. In: Cummings CW, Frederickson JM, Harker LA, et al. editor. Otolaryngology Head and Neck Surgery. Vol 1:St Louis, MO: Mosby; 1998;
For the diagnosis and teaching points, see page 864.
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PII: S0196-0644(09)00405-3
doi:10.1016/j.annemergmed.2009.04.014
© 2009 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
