Dog bite causing intestinal perforation in a child: A case report with review of literature

Deepak Kumar Garnaik; Jaydeep Jain; Enono Yhoshu

doi:10.4103/jiaps.jiaps_47_22



CASE REPORT

Year : 2023 \| Volume : 28 \| Issue : 1 \| Page : 80-81

Dog bite causing intestinal perforation in a child: A case report with review of literature

Deepak Kumar Garnaik, Jaydeep Jain, Enono Yhoshu
Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission	30-Mar-2022
Date of Decision	24-Sep-2022
Date of Acceptance	10-Oct-2022
Date of Web Publication	10-Jan-2023

Correspondence Address:
Enono Yhoshu
6^th Floor A Block, Department of Pediatric Surgery, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh - 249 203, Uttarakhand
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jiaps.jiaps_47_22

Abstract

Dog bite injuries are common in children. They are a major cause of morbidity and mortality involving commonly the extremities, head, and neck. Injuries to the torso represent only 10% of injuries. Visceral injury by a dog bite in children is a rare clinical scenario with very few cases reported. We present a 2-year-old female child who suffered a severe dog bite injury causing colonic perforation.

Keywords: Children, dog bite, intestinal perforation

How to cite this article:
Garnaik DK, Jain J, Yhoshu E. Dog bite causing intestinal perforation in a child: A case report with review of literature. J Indian Assoc Pediatr Surg 2023;28:80-1

How to cite this URL:
Garnaik DK, Jain J, Yhoshu E. Dog bite causing intestinal perforation in a child: A case report with review of literature. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Mar 28];28:80-1. Available from: https://www.jiaps.com/text.asp?2023/28/1/80/367388

Introduction

Dog bites are the most common animal bites. Majority of the wounds are inflicted over extremities and genital area. Visceral injury by a dog bite in children is a rare clinical scenario. Very few cases of intraabdominal injury with visceral perforation secondary to dog bites have been reported.^{[1],[2],[3],[4],[5],[6]} Here we report one such case of severe dog bite with colonic perforation.

Case report

A 2-year female child presented to the emergency department with a history of severe dog bites 4–5 h before presentation. On examination, her vitals were stable and she was irritable. She had multiple deep lacerated wounds on the abdomen, more on the right side through which the bowel was visible [Figure 1]a. Multiple deep bite marks were present on the right lower back, the largest of size 3 cm × 2 cm.

Figure 1: (a) Multiple abrasions and penetrating wounds with visible bowel loop (b) 1 cm × 1 cm ascending colon perforation

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Investigations showed anemia (Hb: 10.7 g/dl) with neutrophilic leukocytosis (total leukocyte count: 12,000/mm³, N–80%) with raised C-reactive protein (4.3 mg/L). X-ray abdomen showed mildly distended bowel loops with no features of free air. The patient was resuscitated with intravenous (IV) fluids, and IV antibiotics – ceftriaxone, amikacin, and metronidazole. Tetanus toxoid, rabies vaccine, and immunoglobulin were administered in view of Category 3 exposure and lack of history eliciting the nature of provocation/attack, the vaccination status of the dog, and postattack behavior of the dog. Exploratory laparotomy revealed a single perforation of size 1 cm × 1 cm in the ascending colon approximately 5–6 cm distal to the cecum [Figure 1]b. Seven Ascaris worms were removed from the jejunum and ileum through the perforation site. After freshening the perforation margins, it was primarily repaired.

In the postoperative period, we upgraded antibiotics to piperacillin/tazobactam, and vancomycin as the patient's clinical course was complicated with pneumonia, wound infection, and abdominal wound dehiscence with exposed bowel. The dehisced wound was managed conservatively with regular dressings, nutritional care, and IV antibiotics. Oral feeds were started on the 4^th postoperative period and gradually increased to full feeds. She was discharged on the 18^th postoperative day after the gradual development of granulation tissue, wound contraction, and resolution of pneumonia.

Discussion

Animal attacks are a serious public health problem and cause significant morbidity and mortality worldwide. A systematic review done to assess the burden of dog-mediated rabies in India found the majority of the wounds were inflicted over extremities and genital area (55%–83.2%) with 1–13.4% of the total wounds over the face, neck, and torso.^[7]

Dog bites in children usually occur in the peripheries, head, and neck owing to the short stature of the pediatric population. In only about 10% of cases, the torso is involved. Severity may vary from superficial wounds to life-threatening injuries. Penetrating visceral injuries are very rare. There are few case reports of visceral injuries following a dog bite. There are reports showing evisceration of the bowel with a serosal contusion. The following case reports were found concerning dog bites leading to visceral injuries [Table 1].

Table 1: Review of literature on intestinal perforation in children caused by dog bites

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In the current report, exploratory laparotomy was done in view of apparent multiple deep dog bites along with few visible bowel loops.

To conclude, for any dog bite injuries in the torso, a high index of clinical suspicion of visceral injury must be kept in mind, and accordingly, a decision to explore the abdomen should be made early. The outcomes of such cases are favorable if managed timely and aggressively.

Authors' contribution

DKG designed, did literature search and drafted the manuscript; EY operated, conceptualized and revised the manuscript critically; JJ helped in literature search and writing the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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3.	Baeza-Herrera C, Martínez-Leo BA, Domínguez-Pérez ST, Ibarra-Hernández CR. Gastric tear caused by dog bite. Acta Pediátrica México 2012;33:109-11.
4.	Mitul AR, Mahmud K. Gastric perforation following dog bite in a child. APSP J Case Rep 2015;6:29.
5.	Singh S, Verma S, Singh P, Pandey A. Gastric perforation following dog bite in a child. J Child Sci 2018;08:e18-20.
6.	Palmer ES, Saysamoneyeu P, Siu JM, Thammaseng A, Trehan I. Down boy! A case of acute abdomen following a dog bite to the scrotum. BMC Pediatr 2019;19:169.
7.	Sudarshan MK, Mahendra BJ, Madhusudana SN, Ashwoath Narayana DH, Rahman A, Rao NS, et al. An epidemiological study of animal bites in India: Results of a WHO sponsored national multi-centric rabies survey. J Commun Dis 2006;38:32-9.