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SAEM Clinical Image Series: Fishing in Papua New Guinea

Posted by Michael Parsa, MD on

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Chief Complaint: Right lower extremity injury while spear fishing

History of Present Illness: A 33-year-old male went river fishing with a homemade spear and diving mask in Papua New Guinea. He felt sudden pain and tugging to the right lower extremity. He was near shore and grabbed a tree root. He held on for dear life as he was being pulled back into the water. It felt as if his foot had been torn off. He did not let go of the tree root and eventually the pulling force ceased. He got out of the water and walked 2 miles unassisted before finding help and hospital transport.

Physical Exam/Imaging

Extremity exam: The foot is well perfused, with sensation intact distally. Minimal movement of toes, no other foot movement.

X-ray: Reveals no fracture

Case Question: What caused this lower extremity injury?

Crocodile bite

The photo with the foot being held up shows the width of the crocodile mouth.

Case Question: How should this injury be managed in a remote bush hospital?

Crocodiles kill their prey by drowning. If this man would have let go of the root he would have died.

This wound was managed with a thorough washout under anesthesia, IV antibiotics, and splinting. The wounds was left open and transport was arranged to a surgical facility.

Do not swim alone in water inhabited by crocodiles.

Crocodile, Alligator, and Caiman Range by Country

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.

Author information

Michael Parsa, MD

Associate Professor and Clerkship Director
Department of Emergency Medicine
Texas Tech University Health Sciences Center El Paso

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