# Management of penetrating cervical injury from needlefish impalement: A case report

## TL;DR

A 50-year-old man survived a rare and potentially fatal neck injury caused by a needlefish impalement, managed through surgical removal and careful monitoring.

## Contribution

This case report presents a rare survival instance of a cervical needlefish injury and outlines a successful management approach.

## Key findings

- Surgical extraction of the needlefish jaw and wound closure led to a successful recovery with no neurological deficits.
- Computed tomography angiography confirmed vessel integrity, guiding the surgical approach.
- Delayed presentation and partial extraction necessitated further intervention for complete removal.

## Abstract

Injuries inflicted by needlefish resemble stab wounds, resulting from the rapid and forceful jumping of needlefish jaws from the water's surface. Needlefish impalement on the neck and face are often fatal compared to body areas or extremities. This case report investigates a rare incident where a 50-year-old male tourist sustained a cervical injury from needlefish impalement during an inter-island cruise.

A 50-year-old male experienced right neck pain due to accidental impalement by a needlefish. The initial extraction attempt at a local health center proved unsuccessful, necessitating subsequent surgical intervention. The procedure involved successful removal of the needlefish jaw, wound cleaning, and primary closure with a penrose drain. The patient was discharged on the third postoperative day, showing no neurological deficits or signs of infection during the four-week follow-up.

Managing needlefish injuries parallels addressing stab wounds, with the treatment approach guided by the specific location of the injury. Zone III injuries in the neck may pose challenges in bleeding control, especially when involving the internal carotid artery. In this case, a diagnostic approach with computed tomography angiography confirmed vessel integrity, allowing for an exploration approach with an L-shaped skin incision.

Penetrating injuries from needlefish can be life threatening. Treatment strategies must target the injured organ, with consideration of further imaging to assess vascular involvement.

•Penetrating cervical injury from needlefish impalement•Management of penetrating cervical injury•Surgical extraction of the needlefish jaw•Delayed presentation and partial extraction

Penetrating cervical injury from needlefish impalement

Management of penetrating cervical injury

Surgical extraction of the needlefish jaw

Delayed presentation and partial extraction