Dahal Amartya, Basi Ashkal, Shrestha Rohit, Khadka Sushant K, Das Arjun, Malla Manasil, Dahal Arshima, Chaudhary Aashutosh
Kathmandu University School of Medical Sciences.
Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel.
Ann Med Surg (Lond). 2024 Jun 4;86(8):4832-4835. doi: 10.1097/MS9.0000000000002253. eCollection 2024 Aug.
Snake bites pose a significant common public health concern, with more prevalence in rural areas. Compartment syndrome (CS) is one of the rare and severe manifestations of snake bite wherein venom-induced swelling within a closed anatomical compartment leads to increased pressure, which may result in ischemic damage to nerves and muscle. Antisnake venom and prompt fasciotomy is recommended for management of CS secondary to snake bite.
Here, the authors report a case of 47-year-old female with Green Pit Viper bite on the left hand. Upon arrival to hospital, initial resuscitation measures were initiated. Six hours following the bite, there was severe pain on passive stretch and paresthesia. Ten vials of antisnake venom administration along with fasciotomy of hand and arm resulted in notable alleviation of pain and swelling. Eighteen pints of blood was transfused for coagulopathy and low hemoglobin. After continued care of wound and intensive physiotherapy, functional limb could be achieved.
Snake bite envenomation is one of the biggest hidden health crises with case fatality rate of 7.8% in the southern plains of Nepal. As in our case, snake bites commonly affect upper extremities, accounting for around two third of all cases. CS must be differentiated from acute swelling, which sometimes may be difficult. Surgical decompression is indicated in presence of signs and symptoms of CS, in case of resource limited setting.
Multidisciplinary and prompt management with initial resuscitation, ASV administration, fasciotomy, and rehabilitative measures can save both life and limb in such cases.
蛇咬伤是一个重大的公共卫生问题，在农村地区更为普遍。骨筋膜室综合征（CS）是蛇咬伤罕见且严重的表现之一，毒液在封闭的解剖腔内引起肿胀，导致压力升高，这可能会导致神经和肌肉的缺血性损伤。对于蛇咬伤继发的CS，建议使用抗蛇毒血清并及时进行筋膜切开术。
在此，作者报告一例47岁女性被竹叶青蛇咬伤左手的病例。入院后，立即采取了初步复苏措施。咬伤后6小时，被动伸展时出现剧痛和感觉异常。给予十瓶抗蛇毒血清并对手和手臂进行筋膜切开术后，疼痛和肿胀明显减轻。因凝血功能障碍和血红蛋白低，输注了18品脱血液。经过持续的伤口护理和强化物理治疗，患肢功能得以恢复。
蛇咬伤中毒是最大的潜在健康危机之一，在尼泊尔南部平原，病死率为7.8%。如我们的病例所示，蛇咬伤通常累及上肢，约占所有病例的三分之二。必须将CS与急性肿胀区分开来，有时这可能会很困难。在资源有限的情况下，出现CS的体征和症状时应进行手术减压。
在这种情况下，通过初步复苏、抗蛇毒血清给药、筋膜切开术和康复措施进行多学科及时管理，可以挽救生命和肢体。
