release. Multiple small puncture wounds are common after the bite of smaller eels, with the hand most
commonly involved. If the eel is ripped forcefully from the victim, the resulting lacerations may be extensive.
Moray bites are treated in a manner analogous to that of shark bites. If the eel remains attached to the
victim, the jaws may need to be broken or the animal decapitated to effect release. The primary wound should
be irrigated copiously and explored to locate any retained teeth. The risk of infection is high, particularly in
bites to the hand. The puncture wounds should be left unsutured to allow drainage and the victim given
appropriate prophylactic antibiotics. If the wound is extensive and more linear in configuration (resembling a
dog bite), the wound edges may be debrided and loosely approximated with nonabsorbable sutures or staples,
and antibiotics may be administered. In all cases, it is prudent to inspect the wound at 24 and 48 hours to
detect the onset of infection.
Sea Lions
Sea lions (family Otaridae) and seals (family Phocidae) are mild-mannered mammals except during
the mating season, when the males may become aggressive, and the breeding season, when both sexes attack
in defense of their newborn pups . Divers have been seriously bitten and therefore should avoid ill-tempered
and abnormally aggressive animals. There is nothing unique about the clinical aspects of these injuries, except
for the posttraumatic infections. The bites are treated the same as shark bites.
"Seal finger" (speck finger, blubber finger) follows a bite wound from a seal or from contact of even a
minor skin wound with a seal's mouth or pelt. The affliction is characterized by swelling of the digit, with or
without articular involvement. There may be lymphadenopathy and involvement of adjacent joints. No
particular organism has been consistently cultured from these injuries, but there has been suggestion that in
addition to Staphylococcus and Streptococcus, Erysipelothrix rhusopathaie may an inciting pathogen.
Needlefish
Marine needlefish (family Belonidae) are slender, tubular, silver, and lightning-quick surface
swimmers found in tropical seas. They resemble, but are not related to, the freshwater gar and may attain
streamlined lengths of up to 2 m. Possessed of an elongated pointed snout, which comprises one quarter the
length of the fish and contains small pointed teeth, the fish moves rapidly, often leaping out of the water in
fear or when attracted to lights or windsurfers. The needlefish, or garfish, is an occupational hazard for
persons who fish from small canoes at night in tropical Indo-Pacific ocean waters. On occasion they have
flown into people, spearing them in the chest, abdomen, extremities, head, and neck. In one reported case a
fish caused brain injury with an internal carotid-cavernous sinus fistula after orbitocranial perforation. In
another case, the calcified elongated jaws of a needlefish embedded in a woman's neck were retained for over
a month prior to removal. In another, penetration of the knee by Tylosurus crocodilus occurred in an ocean
surface swimmer in New Caldedonia. Exsanguination from a neck wound has been anecdotally reported from
Papua New Guinea. A chest wound can be accompanied by a pneumothorax. Death may occur from chest or
abdominal penetration. Treatment is according to the nature of the injury. All wounds should be debrided and
irrigated, followed by a search for foreign material. Radiographs appropriate to identify foreign bodies should
be obtained. A small superficial wound may cause the physician to underestimate an internal injury. The
major risk is wound infection. Injury prevention is difficult, although it has been suggested that canoes be
positioned in a circle to allow spearing of fish in a central pool of light. Other species of flying fish pose less
risk, since they have blunt heads.
Many other fishes leap from the water, but injuries are extremely uncommon. A single case of a
wahoo (150 cm; 22.5 kg), family Scombridae, leaping from the water and biting a victim on the upper
extremity has been reported. The razor-sharp teeth generated extensor tendon lacerations on the dorsal hand
and forearm that required surgical repair. A careless fisherman can easily be cut by a wahoo when extracting a
fishing lure. Bluefish (Pomatomus saltatrix) school and feed in a frenzy, but most bites occur as the fish are
handled out of the water; in-water attacks on humans are theoretical. The fish has sharp, conical canine teeth
in both the upper and lower jaws and can grow to 1.2 m and over 12 kg.
The sailfish sports an elongated bill. Although not considered a predator, a sailfish has on at least a
few occasions driven its bill into a human victim, in one case causing a colon perforation in a snorkeler.
Mantis Shrimp
The mantis shrimp (e.g., Gonodactylus bredini, Hemisquilla ensigera californiensis) is not a true
shrimp, but resembles a large flattened shrimp or miniature lobster (up to 36 cm) and is equipped with a pair
