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

Abstract

Patient: Male, 62Final Diagnosis: Splenic hemorrhageSymptoms: Hypotension • syncopeMedication: —Clinical Procedure: Splenic artery angio-embolizationSpecialty: Critical Care MedicineObjective:Rare diseaseBackground:Snakebite envenoming results from injection of a mixture different toxins following snakebite. Coagulopathy and life-threatening hemorrhage can occur, or venom-induced consumption coagulopathy (VICC). A rare case is presented of spontaneous splenic hemorrhage due to VICC that was successfully treated by non-surgical splenic artery embolization.Case Report:A 62-year-old man was admitted to the emergency department after an episode of dizziness and loss of consciousness following a snakebite. He was transferred to our hospital with hypotension and an abnormal blood coagulation test. On admission, he was hypotensive, with reduced hemoglobin and hematocrit levels, but did not complain of abdominal pain. The occult source of bleeding was identified by abdominal computed tomography (CT) as splenic hemorrhage. Treatment began with the administration of antivenom and blood transfusion. Splenic artery angio-embolization was performed to control the bleeding and was without complication.Conclusions:Snakebite envenoming associated with VICC is a serious and life-threatening condition. Because of the possibility of associated occult bleeding from internal organs or blood vessels, imaging studies should be performed as soon as possible. For patients who are hemodynamically stabilized and have atraumatic hemorrhage from the spleen, non-operative treatment using angio-embolization may be performed with intensive monitoring and follow-up.

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

“…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.…”

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

“…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).…”