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A fishy foreign body
ln~ury(1985) 16, 341-342
Printedin Great Britain
A fishy foreign
341
body
T. K. George A 8 E Department, CASE
Victoria Hospital, Blackpool
REPORT
A 23-year-old male attended the Accident and Emergency Department of Victoria Hospital, Blackpool, complaining of pain in the right index finger. He gave a history of having been ‘bitten’ by a fish while swimming a week previously, while on holiday in Florida, USA. Because of the sharp pain, he sought medical attention at a local hospital, where the finger was cleaned and dressed, a tetanus toxoid injection administered and a course of antibiotics prescribed. On return to Britain, the patient was referred by his general practitioner because of persistent pain in the finger tip and inability to apply pressure to the pulp. On examination, the right index finger revealed a healed tender scar just distal to the dorsal crease at the distal interphalangeal joint. There was no swelling or redness of the finger. Flexion was restricted by 20” at the distal interphalangeal joint and X-ray films showed the presence of a radio-opaque foreign body at this site (Fig. 1, top). This was removed under local anaesthesia. A week later, the patient had no complaints; the wound had healed, with a normal range of movements of the finger. The specimen removed from the finger was a white, triangular object with sharp retrorse teeth (Fig. 1, bottom). Despite the patient’s history of being ‘bitten’, and speculation as to whether the foreign body removed could be a fish tooth, the specimen was later identified as one of the serrated poison spines of a marine catfish. DISCUSSION Stings by marine animals are uncommon in Britain. Patients with stings by the weever fish may occasionally go to Accident and Emergency Departments in coastal towns of Britain (Cain, 1983). Stingray and stonefish injuries are more serious than those of the catfish (Edmonds, 1976). The catfish spines, so constructed that they can be firmly locked into a rigid extended position at the will of the fish, are very sharp and will readily penetrate the skin of the victim. The severity of symptoms varies with the species and the amount of venom received. The pain may radiate up the entire limb. The area about the wound, initially ischaemic, may later appear cyanotic and erythematous. Massive oedema of a limb, with lymphadenopathy, numbness and gangrene can also occur (Halstead, 1978). The patient in this report had only pain following the sting. It is presumed that the venom injected was not very poisonous or that the sting did not contain much venom. Also the pain experienced by this patient was not as intense as in some cases of sting injuries mentioned in the literature. A case is mentioned of a man who, following a weever sting injury to his middle finger, amputated the digit in a desperate attempt to relieve the pain (Halstead, 1978). Although rupture of a spine into the wound is
Fig. 1. Top, Radiograph showing foreign body. Bottom, Catfisih
spine removed from patient. common with stingray frequency of a similar could not be determined
injuries (Edmonds, 1976), th le occurrence with catfish sting :s from the literature reviewed.
342
Injury: the British Journal of Accident Surgery (1985) Vol. 1 ~/NO. 5
Acknowledgement
Edmonds C. (1976) Dangerous marine animals. Aust. Fun. Physicians 5(3), 381. Halstead B. M. (1978) Poisonous and Venomous Marine Animals c$fthe World. Princeton, NJ: Darwin Press Inc.
I would
like to thank Professor D. M. Guthrie, Department of Zoology, Manchester University, for identifying the specimen; Dr J. T. Dennis, Consultant in Accident and Emergency Medicine, for permission to report the case; and Miss J. M. Latham for typing the manuscript.
Paper accepted 8 June 1984.
REFERENCES
Cain D. (1983) Weever fish sting: an unusual problem. Br. Med. J. 287, 406.
Requests for reprintsshould be addressed to: T. K. George, Senior Registrar, Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR.
Printedin Great Britain
A fishy foreign
341
body
T. K. George A 8 E Department, CASE
Victoria Hospital, Blackpool
REPORT
A 23-year-old male attended the Accident and Emergency Department of Victoria Hospital, Blackpool, complaining of pain in the right index finger. He gave a history of having been ‘bitten’ by a fish while swimming a week previously, while on holiday in Florida, USA. Because of the sharp pain, he sought medical attention at a local hospital, where the finger was cleaned and dressed, a tetanus toxoid injection administered and a course of antibiotics prescribed. On return to Britain, the patient was referred by his general practitioner because of persistent pain in the finger tip and inability to apply pressure to the pulp. On examination, the right index finger revealed a healed tender scar just distal to the dorsal crease at the distal interphalangeal joint. There was no swelling or redness of the finger. Flexion was restricted by 20” at the distal interphalangeal joint and X-ray films showed the presence of a radio-opaque foreign body at this site (Fig. 1, top). This was removed under local anaesthesia. A week later, the patient had no complaints; the wound had healed, with a normal range of movements of the finger. The specimen removed from the finger was a white, triangular object with sharp retrorse teeth (Fig. 1, bottom). Despite the patient’s history of being ‘bitten’, and speculation as to whether the foreign body removed could be a fish tooth, the specimen was later identified as one of the serrated poison spines of a marine catfish. DISCUSSION Stings by marine animals are uncommon in Britain. Patients with stings by the weever fish may occasionally go to Accident and Emergency Departments in coastal towns of Britain (Cain, 1983). Stingray and stonefish injuries are more serious than those of the catfish (Edmonds, 1976). The catfish spines, so constructed that they can be firmly locked into a rigid extended position at the will of the fish, are very sharp and will readily penetrate the skin of the victim. The severity of symptoms varies with the species and the amount of venom received. The pain may radiate up the entire limb. The area about the wound, initially ischaemic, may later appear cyanotic and erythematous. Massive oedema of a limb, with lymphadenopathy, numbness and gangrene can also occur (Halstead, 1978). The patient in this report had only pain following the sting. It is presumed that the venom injected was not very poisonous or that the sting did not contain much venom. Also the pain experienced by this patient was not as intense as in some cases of sting injuries mentioned in the literature. A case is mentioned of a man who, following a weever sting injury to his middle finger, amputated the digit in a desperate attempt to relieve the pain (Halstead, 1978). Although rupture of a spine into the wound is
Fig. 1. Top, Radiograph showing foreign body. Bottom, Catfisih
spine removed from patient. common with stingray frequency of a similar could not be determined
injuries (Edmonds, 1976), th le occurrence with catfish sting :s from the literature reviewed.
342
Injury: the British Journal of Accident Surgery (1985) Vol. 1 ~/NO. 5
Acknowledgement
Edmonds C. (1976) Dangerous marine animals. Aust. Fun. Physicians 5(3), 381. Halstead B. M. (1978) Poisonous and Venomous Marine Animals c$fthe World. Princeton, NJ: Darwin Press Inc.
I would
like to thank Professor D. M. Guthrie, Department of Zoology, Manchester University, for identifying the specimen; Dr J. T. Dennis, Consultant in Accident and Emergency Medicine, for permission to report the case; and Miss J. M. Latham for typing the manuscript.
Paper accepted 8 June 1984.
REFERENCES
Cain D. (1983) Weever fish sting: an unusual problem. Br. Med. J. 287, 406.
Requests for reprintsshould be addressed to: T. K. George, Senior Registrar, Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR.