Atraumatic Splenic Rupture After Coagulopathy Owing to a Snakebite

Abstract

Among the many complications that may follow envenomation by some species of venomous snakes, coagulopathy is common and well known. However, hemoperitoneum induced by coagulopathy after a snakebite is rare. Atraumatic spontaneous splenic rupture is also an uncommon and life-threatening condition. Here, we report a case of presumptive envenomation by Gloydius spp. that resulted in atraumatic splenic rupture as a probable manifestation of coagulopathy, which has not been previously reported.

A Case of Non-Operative Management of Atraumatic Splenic Hemorrhage Due to Snakebite Venom-Induced Consumption Coagulopathy

“…In the present case, there was no recent trauma, and treatment was successfully performed with non-surgical management. Unlike previously reported cases [5,6], splenectomy and histology of the spleen were not performed. Therefore, it was not possible to exclude other causes of splenic hemorrhage, such as the presence of tumors or infection.…”

“…Currently, there have been few previously reported cases of spontaneous atraumatic liver or splenic hemorrhage due to snakebite [4–6]. In most previously reported cases, inaccessibility of the splenic artery prevented arterial embolization, and if arterial embolization was performed, the patients were hemodynamically unstable and required splenectomy [4–6]. When surgery was performed, mechanical ventilation and continuous hemodialysis were required due to complications from surgery [5,6].…”

Splenic Rupture and Massive Hemoperitoneum Due to Coagulopathy after Atheris Viper Snakebite

“…Hemoperitoneum accompanying VICC is described rather sporadically (Rathod et al, 2003;Ahn et al, 2007;Diallo et al, 2019). Splenic rupture is then very rare complication (Kang et al, 2014;Lal et al, 2014).…”

“…Activated red pulp was probably congested, among others, even due to the number of hemolyzed erythrocytes. Also, the endothelial and subendothelial vascular injury caused by venoms hemorrhagines and other enzymes can be expected (Kang et al, 2014;Berling and Isbister, 2015). This, together with ongoing plasma coagulation system failure during VICC, caused numerous and confluent hemorrhages found in the parenchyma.…”

“…Hemoperitoneum as a consequence of VICC is a relatively rare complication. Non-traumatic splenic rupture and bleeding after snakebite has been described so far in three cases, of which only in one case initially intact spleen with massive hemoperitoneum and splenectomy necessity, has occurred (Kang et al, 2014;Lal et al, 2014;Lee and Sung, 2019).…”