The Compartment Syndrome Associated with Deep Vein Thrombosis due to Rattlesnake Bite: A Case Report

Abstract

Background:Snakebite is a health issue specific to some parts of the world, especially in the tropical areas, where it produces many victims. The main clinical damage caused by snakebite involves haemotoxic, neurotoxic and myotoxic reactions. We report the case of a young woman suffering from snakebite who developed deep vein thrombosis and compartment syndrome.Case Report: We present the case of a 32-year-old Romanian woman who was injured by her own Crotalinae snake (also known as pit viper or rattlesnake) on her left forearm. When admitted to our Emergency Department, she was conscious with a Glasgow coma scale of 12/15, somnolent, febrile, suffering of headache, tachypnoea; the marks of the snakebite were located in the distal part of the anterior left forearm; she had pain and bleeding at the bite site and swelling of the left upper limb with lymphangitis up to the axilla. She experienced fasciotomy-requiring compartment syndrome of the upper limb and required unfractionated heparin and close monitoring using activated partial thromboplastin time evolution due to micro-thrombosis in the brachial vein. Local improvement was achieved in the next 4 days with progressive diminishment of local tenderness and swelling.Conclusion: Limb deep vein thrombosis might be induced by snakebite, despite the pro-haemorrhagic general condition induced by the envenomation. A high index of clinical suspicion is needed for early diagnosis and timely management, which can improve survival of these patients.

The Role of Point-of-Care Ultrasound (POCUS) in Envenomation by a Desert Viper

“…Compartment syndrome in the extremities (and even in the abdominal compartment) can develop after crotaline envenomation [ 8 – 10 ]. Of particular relevance to Qatar, a 2017 report from neighboring Saudi Arabia found an incidence of compartment syndrome of just over 3% [ 11 ].…”

“…The difficulty of differentiating venom effects from early compartment syndrome can lead to delayed diagnosis and unsalvageable tissue [ 8 , 12 ]. Patients should be warned that fasciotomy will not necessarily save necrotic muscle after envenomation, and fasciotomy should probably not be undertaken until coagulation parameters are restored [ 6 ].…”

Experience of Snakebite Envenomation by a Desert Viper in Qatar

“…Also, the patient should be evaluated for venous thrombosis in the affected limb due to slow blood flow. It can happen even when the patient is experiencing hemorrhage in the rest of the body [ 29 ]. Antibiotics are commonly used in snakebite cases to prevent wound infection.…”

“…Once the patient develops bleeding complications, clotting factors and platelets are replaced as required. As the patient may also develop deep venous thrombosis (DVT), early use of these clotting factors, etc., is avoided [ 29 ].…”

Compartment Syndrome following Bothrops Snakebite Leads to Decompressive Fasciotomies

“…In this report, we illustrate the clinical course of the Bothrops snakebite that progressed to compartment syndrome followed with decompressive fasciotomies to reduce pressure within the affected compartment. Very few case reports have reported postsnakebite compartment syndrome [ 5 – 9 ].…”