Captive Tiger Attack: Case Report and Review of the Literature HENRY J. SCHILLER, M.D., DANIEL C. CULLINANE, M.D., MARK D. SAWYER, M.D., SCOTT P. ZIETLOW, M.D. From the Division of Trauma, Critical Care and General Surgery, Mayo Foundation, Mayo Clinic, Rochester, Minnesota Tigers, as well as other large predators, are being held in private settings with increasing fre- quency. Unregulated private “zoos” are cropping up in many rural and suburban settings across the country. The number of attacks from captive predators also is on the rise. This case highlights the potentially violent and aggressive nature of wild animals held in captivity. Treatment prin- cipals and wounding patterns of large cat attacks are emphasized. A LTHOUGH RARE IN THE United States, large cat at- tacks continue to occur, and may involve captive animals such as tigers. The size and strength of these animals, and their tendency to attack their victim’s neck, make the injuries they inflict unique and dis- tinct from those seen more commonly from domes- ticated dogs. 1–4 For patients surviving the initial at- tack, wound superinfection may result from a wide variety of bacteria. Rabies may also be transmit- ted. 1, 4–6 This report presents the case of a 37-year-old woman who was attacked by a 700-lb. Siberian tiger. The tiger was kept with five other tigers in a private zoo in rural Minnesota. She required multiple surgical procedures and intensive physical rehabilitation. She also required psychiatric care and grief counseling for the emotional trauma she suffered when the animals were threatened with destruction. This case underscores the dangerous nature of feral predators. Tiger attacks may occur anywhere because of an increasing number of these feral animals kept in unlicensed, unregulated “private zoos” or as pets. 7, 8 This attack represents the second tiger attack victim treated at our institution in the last 4 years 5 and the third known attack from this particular private zoo. The frequency of these attacks in a rural environment poses a significant public health risk and makes knowledge of the resultant injuries and their treatment necessary. Case Report A 37-year-old woman was attacked by a 700-lb. Siberian tiger while cleaning the animal’s cage at a private zoo. She was first bitten on the neck and held to the ground for approximately 30 seconds by the animal. There was no loss of consciousness. She then was attacked on both lower ex- tremities. She arrived at St. Mary’s Hospital in Rochester, Minnesota, via helicopter transport. Examination revealed multiple injuries to her left neck. The largest wound was a nonbleeding 6-cm supraclavicular laceration. She also had multiple large puncture wounds over the anterior neck, posterior shoulder, and midline pos- terior neck (Fig. 1). Neurologic examination of the left up- per extremity revealed mild weakness of the left biceps and triceps muscle. Both lower extremities had wounds grossly contaminated with dirt and hay. The right leg had multiple lacerations with skin degloved, but the leg was neurovascularly intact and without bony injury. The left lower extremity had ob- vious massive soft tissue injury with fibular bone fragments and muscle loss (Fig. 2). Distal pulses were not palpable, but triphasic Doppler signals were present distally. She was able to move her toes and had sensation over the dorsal and plantar surfaces of the foot. X-ray examination of the left leg confirmed a fracture of the fibula (Fig. 3). Initial chest X-ray and subsequent fluoroscopy revealed and elevated left hemidiaphragm from phrenic nerve injury. Lateral cervical spine X-ray and cervical spine CT scan demonstrated a large amount of air within the fascial planes of the neck, as well as comminuted fractures of the C3 body with a locked C2/C3 facet. The left jugular vein was throm- bosed, as was the left vertebral artery at the level of the C3 fractures. She was promptly taken to the operating room. Once hemostasis was obtained in the left leg, surgical exploration of her left neck was performed by the trauma team, while the orthopedic team continued exploration, irrigation, and drainage of her lower extremity injuries. The trachea, esophagus, and carotid artery were found to be without injury, and the previously identified thrombosed left jugular Address correspondence and reprint requests to Daniel C. Cul- linane, M.D., Mayo Clinic, 200 First Street, SW Rochester, MN 55905. Presented at the 36th Annual Meeting of the Western Trauma Association, March 3, 2006, Big Sky, MT. 516