SKIRMISHER

Some dude tried to kill himself by shooting an arrow through his neck. Let’s just hope his crushing failure at attempting to accomplish something won’t stop him from trying again.

A 25-year-old man, presented to the accident and emergency department, after having fired an 18-inch arrow with a metal point from a crossbow just beneath his chin in an attempt to kill himself.

He was known to be addicted to cocaine, was depressed, and had been feeling low for several months. He had tried to explain his state of mind to his girlfriend, and a month later he attempted suicide.

The entry point of the arrow was apparent through the anterior part of the neck, and close to the midline. There was no active bleeding. The arrow crossed the mouth and had passed behind the soft palate, which resulted in mechanical trismus and therefore a potentially difficult intubation.

Nasotracheal fibreoptic intubation [camera through the nose] was eventually completed. With the patient anaesthetised, plain radiographs and computed tomograms (CT) were taken urgently; these showed that the arrow had passed up through the brain, and the tip was protruding through a comminuted fracture of the skull vault.

In view of the location, and to assess soft tissue damage further, a magnetic resonance cerebral angiogram was taken, which showed the anatomy clearly, in particular no vascular injury.

The patient was therefore transferred to the nearest neurosurgical centre for definitive treatment. Under general anaesthesia and together with the maxillofacial surgeons, the arrow was withdrawn gently along the precise path of its insertion. This was followed by profuse bleeding from behind the soft palate and base of skull, which had been anticipated and was controlled by a post-nasal pack. No further intervention proved necessary.

His recovery was uneventful, but he lost the sight in his right eye as a result of damage to the right optic nerve. No other neurological deficit was documented. The patient was given psychiatric care for several months for further management of his depression, which had been the cause of his attempted suicide.

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