Delayed Splenic Rupture: A Rare Complication of Snakebites

Abstract

Bites by venomous snakes can cause fatal systemic and coagulation disorders. Rare complications, such as compartment syndrome and hemoperitoneum, may also require surgical intervention. Here, we describe our experience with an unusual case of snakebite-induced delayed splenic rupture. A 54-yold male with no specific medical history visited a local hospital for a bite by an unidentified snake. He had been bitten on the left thumb and was administered antivenom. He was discharged from the local hospital after 3 d when his symptoms had improved. However, he revisited our emergency medical center 2 d later, reporting dizziness with diaphoresis. Focused abdominal ultrasonography and computed tomography revealed large amounts of intraperitoneal fluid collection and hemoperitoneum with splenic rupture, respectively. The patient underwent immediate blood transfusion and received antivenom treatment in our emergency department and, subsequently, emergency splenectomy. Histopathologic findings at the time of surgery revealed multifocal lacerations on the external surface of the spleen, with fresh hemorrhage. He recovered 7 d after surgery without any complication.

Splenic rupture and subsequent splenectomy in a young healthy victim following Russell's viper bite

“…Similar to this present case, another SBE incident from South Korea has reported the development of abdominal pain, disorientation, drowsiness, and nausea two days after antivenom treatment (Lee and Sung, 2019). Tachycardia and hypotension along with a significant reduction in haemoglobin level observed in this case closely matches with the symptoms experienced by a SBE victim reported from South Korea (Kim et al, 2021). Other common symptoms observed in our case were also similar to the cases reported earlier (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013).…”

“…Similarly, a total of four cases of splenic rupture following bites from unidentified snake species one to five days after receiving antivenom were reported from South Korea (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013). Among these cases, three underwent splenectomy (Kang et al, 2014;Kim et al, 2021;Yhi et al, 2013) and in one case, it was averted by successful angioembolisation of splenic artery (Lee and Sung, 2019). To our knowledge, splenic rupture and subsequent splenectomy in Russell's viper bite victims has not been previously reported.…”

“…Prior to this study, a cobra bite-induced splenic congestion was observed in a victim in 19 th century (as reviewed in (Feola et al, 2020)). Similarly, a total of four cases of splenic rupture following bites from unidentified snake species one to five days after receiving antivenom were reported from South Korea (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013). Among these cases, three underwent splenectomy (Kang et al, 2014;Kim et al, 2021;Yhi et al, 2013) and in one case, it was averted by successful angioembolisation of splenic artery (Lee and Sung, 2019).…”

“…However, it can also occur without traumatic injury which is known as atraumatic, non-traumatic or spontaneous splenic rupture less frequently due to various causes (Lieberman and Levitt, 1989). Multiple systematic analyses were performed on the causes of atraumatic splenic rupture, however, SBE (specifically Russell's viper bite) has not been previously reported as a causative reason (Lieberman and Levitt, 1989;Renzulli et al, 2009) although few cases of splenic rupture following SBE have been reported (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013). A single case reported in the 19 th century demonstrates a cobra bite leading to congestion in all organs including spleen (reviewed in (Feola et al, 2020)).…”

“…A single case reported in the 19 th century demonstrates a cobra bite leading to congestion in all organs including spleen (reviewed in (Feola et al, 2020)). Similarly, few case studies have reported splenic rupture following SBE from unidentified snake species in South Korea (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013). Moreover, spontaneous splenic rupture due to antivenom treatment has not been reported either.…”