Compartment Syndrome Complicating Snakebite; a Clinician’s Dilemma

Jimba Jatsho

Department of Neonatology, Phuentsholing Hospital, Bhutan

^*Correspondance to: Jimba Jatsho 

 PDF  Full Text Case Report | Open Access

Abstract:

Background: A diagnosis of compartment syndrome warrants a need for fasciotomy. We present a case of compartment syndrome complicating snakebite where prophylactic fasciotomy was not done following response to anti snake venom serum.
Case Presentation: We present a case of an11year old boy with compartment syndrome of left upper limb following a snake bite. The patient presented with progressively worsening local envenomation symptoms. A diagnosis of compartment syndrome was made and orthopedic team was consulted. With a prolonged 20 min Whole Blood Clotting Time (WBCT) and deranged coagulation profile, joint decision was made to start Anti-Snake Venom (ASV) and withhold fasciotomy unless there was no evidence of improvement. He developed an early allergic reaction to the polyvalent antivenom which was promptly managed. Subsequently his coagulation profile began normalizing after
completion of the anti-venom. His swelling and pain over the forearm reduced significantly with normal peripheral perfusion. With improvement of symptoms any surgical interventions were withheld. He responded well to the anti-venom despite late administration and was discharged on day 7 of admission.
Conclusion: Initiation of anti-venom should not be held for delayed presentation of snakebites. It is prudent to start ASV first with closely monitoring and consider surgery only if compartment symptoms persist with failed response to ASV. Anti-venom can, not only reverse coagulopathy, but may also be helpful in reducing symptoms of compartment syndrome, thereby negating the need for fasciotomies.

Keywords:

Snakebite; Anti-snake venom; Fasciotomy; Compartment syndrome

Cite the Article:

Jatsho J. Compartment Syndrome Complicating Snakebite; a Clinician’s Dilemma. Clin Case Rep Int. 2020;4:1179..