When snakebites complicate: a paediatric case with shock and compartment syndrome

Abstract

We report the case of an 11-year-old boy brought to our emergency department 2 hours after a viper bite to his right hand. He suffered severe pain and rapidly progressive swelling with signs of haemodynamic compromise in keeping with distributive shock. The oedema progressed from his right wrist upwards to his forearm and upper arm with compartment syndrome ultimately resulting. He underwent fasciotomy of the right upper limb and antivenom serum was given. The patient required vasopressors for 48 hours and a total of nine surgical interventions were necessary. In the event of a snakebite, it is essential to promptly recognise the signs of severity, complications and indications for the administration of antivenom serum. We intend to highlight this rare shock aetiology and the need for emergency management if severe clinical signs are present. Early administration of antivenom serum is essential and it should be available in all emergency departments.

Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives

“…In common for the three cases of this study, the Bothrops snakebite evolved to compartment syndrome, secondary bacterial infection and extensive necrosis, leading to atrophy and amputation of the bitten limb. Local tissue damage is an important effect in human victims of Bothrops snakebites and, in the most severe cases, compartment syndrome appears as a dangerous complication due to the possibility of ischemia, tissue necrosis and neuropathy [ 34 , 35 , 36 , 37 ]. Pediatric cases of compartment syndrome from snakebites are reported worldwide [ 37 , 38 , 39 , 40 ], in clinical pictures very similar to those seen in this study.…”

“…Local tissue damage is an important effect in human victims of Bothrops snakebites and, in the most severe cases, compartment syndrome appears as a dangerous complication due to the possibility of ischemia, tissue necrosis and neuropathy [ 34 , 35 , 36 , 37 ]. Pediatric cases of compartment syndrome from snakebites are reported worldwide [ 37 , 38 , 39 , 40 ], in clinical pictures very similar to those seen in this study. In the Brazilian Amazon, an analysis of cases reported by the epidemiological surveillance system revealed that children up to 12 years old had a significantly higher risk of severe local complications, such as compartment syndrome, which often result in amputations [ 41 ].…”

Mordeduras de ofidios en mano pediátrica y sus complicaciones locales

“…La administración del suero antiofídico es el único tratamiento eficaz frente al envenenamiento (14) y su administración debe considerarse una emergencia.…”

“…El tratamiento indiscutible en la bibliografía es: suero antiofídico, elevación de zona afectada, analgesia y control del sangrado (1,4,13). La mayoría de los autores coinciden que una dosis específica de suero antiofídico neutraliza un volumen fijo de veneno (4,14). No se administra menor dosis de suero antiofídico a los pacientes pediátricos por tener menor peso.…”

“…Existen múltiples trabajos publicados con tratamientos quirúrgicos del síndrome compartimental en mano, con o sin cierre precoz de las fasciotomías y posterior rehabilitación con buenos resultados funcionales (13). De los 9 artículos con casos clínicos o series de casos que hacen referencia al tratamiento del síndrome compartimental, 8 refieren realizar fasciotomías con buenos resultados funcionales (7,13,14,19,(23)(24)(25)(26), 6 trabajos lo realizan luego del diagnóstico clínico (7,13,14,19,23,24) y 2 refieren la necesidad de constatar presiones intracompartimentales elevadas para indicar las fasciotomías (25,26). flictenas en vistas de reducir el daño tisular (33).…”