Acute mesenteric ischemia following lancehead snakebite: an unusual case report in the Northernmost Brazilian Amazon

Abstract

Snakebites have a great impact in the Brazilian Amazon, being the lancehead Bothrops atrox the species responsible for most accidents, disabilities, and deaths. This study shows a case report of an indigenous patient from the Yanomami ethnicity, male, 33 years-old, envenomed by a B. atrox snake. Envenoming caused by B. atrox are characterized by local manifestations (e.g., pain and edema) and systemic manifestations, mainly coagulation disorders. The indigenous victim was admitted in the main hospital of Roraima and evolved with an unusual complication, an ischemia and necrosis of the proximal ileum, requiring segmental enterectomy with posterior side-to-side anastomosis. The victim was discharge after 27 days of hospitalization with no complaints. Snakebite envenomations may evolve with life-threatening complications, which can be treated by the antivenom following access to a healthcare unit, often late in indigenous population. This clinical case shows the need of strategies that aim improvement in the access to the healthcare by indigenous people, as well as demonstrates an unusual complication that may result from lancehead snakebites. The article also discusses the decentralization of snakebites clinical management to indigenous community healthcare centers to mitigate complications.

Bothrops venom-induced hemostasis disorders in the rat: Between Scylla and Charybdis

“…Consistent with the inflammatory response to venom, marked increase in C reactive protein (CRP) has been reported in B. lanceolatus-bitten patients [47,62]. However, thrombosis is not specific of B. lanceolatus envenomation but may rarely occur with B. atrox bite [79,80]. In an acute mesenteric ischemia case, mild coagulopathy associated with a marked inflammatory syndrome including hyperleukocytosis and increased CRP was described [80].…”

“…However, thrombosis is not specific of B. lanceolatus envenomation but may rarely occur with B. atrox bite [79,80]. In an acute mesenteric ischemia case, mild coagulopathy associated with a marked inflammatory syndrome including hyperleukocytosis and increased CRP was described [80]. In another ischemic stroke case, limited alterations in hemostasis were reported on day 4 despite early antivenom administration [79].…”

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review

“…SBE may manifest with abdominal complications, often heralded by severe abdominal pain and discomfort. These symptoms are often mistaken for other abdominal pathologies, such as appendicitis, peritonitis, or cholecystitis [ 65 ]. A case following lancehead ( Bothrops atrox ) envenoming reported a patient with severe abdominal pain in the right flank and iliac fossa [ 65 ].…”

“…These symptoms are often mistaken for other abdominal pathologies, such as appendicitis, peritonitis, or cholecystitis [ 65 ]. A case following lancehead ( Bothrops atrox ) envenoming reported a patient with severe abdominal pain in the right flank and iliac fossa [ 65 ]. The cause of the abdominal pain was identified as acute mesenteric and bowel ischaemia, as evidenced on CT scan.…”

“…Although the mechanism is not fully understood, the prothrombotic effects of venom proteins are thought to increase platelet activity through the formation of distal microthrombi and visceral infarctions [ 66 ]. Although the patient had antivenom administered, surgery was performed, and the patient made a full recovery [ 65 ].…”