Management of Bengal tiger attacks - A case report and literature review

While the number of tigers in the wild continues to decline, so do the number of tigers in captivity continue to rise. This phenomenon has reached such proportions that today more tigers exist in captivity in the United States alone, than the total number of wild tigers scattered in pockets across the remaining reserves in south-east Asia, china and Russia combined. While not endemic to South Africa, a similar trend is observed with a very recent report noting that there are currently approximately 280 tigers spread across 44 reserves in the country. Being the largest and most powerful big cat, with an adult male weighing approximately 250 kg, combined with a specific predilection for attacking the cervical region of its victims, means that tiger attacks can inflict devastating injuries. The evolutionary development of tigers has further been found to be purposively directed to inflict maximal cervical damage. Proprioreceptors, found in the mouth and teeth of tigers, enable then to align their bite parallel to the cervical vertebra and, during subsequent cervical extension, the purposively sever the cervical spinal cord. We report a case of an adult female patient who was attacked by a Bengal tiger on a privately owned South African wildlife reserve. The mechanism of injury mirrored the typical nature of tiger attacks where, post biting into her neck, and subsequent lateral extension, an open cervical fracture occurred complicated by a vascular injury. Post violently pulling her to the ground the animals massive forebody weight was further exerted onto her left shoulder resulting in a closed 4-part proximal humeral fracture. While the details of how she escaped being killed are obscure, she managed to present to our unit needing urgent multidisciplinary management. Fortunately, subsequently to our immediate interventions, we report a successful outcome.