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The Indian Journal of Pediatrics

, Volume 71, Issue 5, pp 397–399 | Cite as

Surgical implications of snakebites

  • Anindya ChattopadhyayEmail author
  • Rishab Dev Patra
  • Vijaya Shenoy
  • Vijay Kumar
  • Yoga Nagendhar
Original Article

Abstract

Objective : Snakebites are a common problem in the pediatric age group. Local complications such as necrosis and compartment syndrome threaten limb survival even after control of systemic manifestations. Few recommendations exist about the nature and timing of surgical treatment.Methods: A retrospective review of all children with snakebites presenting to the hospital was undertaken over a 6-year period. Records were reviewed with special emphasis on the type of surgical lesions seen and the treatment offered and their results.Results: 44 of the 58 children required some form of local therapy. In the majority conservative treatment was successful. 28% of the patients needed debridement for local necrosis, and only 5 needed a skin graft, with good functional results over a period of 1 to 45 days. One child underwent an above knee amputation. Patients who required surgical intervention received significantly more vials of antivenin.Conclusion: Local complications of snakebite are frequent, but can be managed conservatively. Delayed excision of the resultant local necrosis is associated with good outcomes. The need for fasciotomy is rare.

Key words

Snakebites Envenomation Local complications Necrosis 

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References

  1. 1.
    Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases.Indian Pediatr 1994; 31: 1239–1242.PubMedGoogle Scholar
  2. 2.
    Pillay VV. Bites and stings. InHandbook of Forensic Medicine and Toxicology, 12th edn. Bangalore, Paras Medical Publishers, 2001; 345–350.Google Scholar
  3. 3.
    Lopoo JB, Bealer JF, Mantor C, Tuggle DW. Treating the snakerbitten child in North America: a study of pit viper bites.J Pediatr Surg 1998; 33: 1593–1595.PubMedCrossRefGoogle Scholar
  4. 4.
    Cawrse NH, Inglefeild CJ, Hayes C, Palmer JH. A snake in the clinical grass: late compartement syndrome in a child bitten by an adder.Br J Plast Surg 2002; 55: 434–435.PubMedCrossRefGoogle Scholar
  5. 5.
    Wilkinson D. Retrospective analysis of snakebite at a rural hospital in Zululand.S Afr Med J 1994; 84: 844–847.PubMedGoogle Scholar
  6. 6.
    Otero R. Gutierrez J, Beatriz Mesa M, Duque E, Rodriguez O, Luis Arango J. Complications ofBothrops, Porthidium and Bothreidis snakebites in Colombia. A clinical and epidemiological study of 39 cases attended in a university hospital.Toxicon 2002; 40: 1107–1114.PubMedCrossRefGoogle Scholar
  7. 7.
    Ribeiro LA, Jorge MT, Lebrao ML. Prognostic factors for local necrosis inBothrops jararaca (Brazilian pit viper) bites.Trans Roy Soc Trop Med Hygeine 2001; 95: 630–634.CrossRefGoogle Scholar
  8. 8.
    Tokish JT, Benjamin J, Walker F. Crotalid envenomation: the southern Arizona experience.J Orthop Trauma 2001; 15: 5–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Weber RA, White RR. Crotalidae envenomation in children.Ann Plast Surg 1993; 31: 141–145.PubMedCrossRefGoogle Scholar
  10. 10.
    Glass TG Jr. Early debridement in pit viper bites.JAMA 1976; 235: 2513–2516.PubMedCrossRefGoogle Scholar
  11. 11.
    Shaw BA, Hosalkar HS. Rattlesnake bites in children: (crotalus) anrivenom treatment and surgical indications.J Bone Joint Surg Am 2002; 84-A(9): 1624–1629.PubMedGoogle Scholar
  12. 12.
    Forks TP. Evaluation and treatment of poisonous snakebites.Am Fam Physician 1994; 50: 123–130.PubMedGoogle Scholar
  13. 13.
    Stewart RM, Page CP, Schwesinger WH, McCarter R, Martinez J, Aust JB. Antivenin and fasciotomy/debridement in the treatment of sever rattlesnake bite.Am J Surg 1989; 158: 543–547.PubMedCrossRefGoogle Scholar
  14. 14.
    Jorge MT, Ribeiro LA, Silva MLR, Kusano EJU, Mendonca JS. Microbiological studies of abscesses complicatingBothrops snakebite in humans: a prospective study.Toxicon 1994; 32: 743–748.PubMedCrossRefGoogle Scholar
  15. 15.
    Rudolph R, Neal GE, Williams JS, McMohan AP. Snakebite treatment at a southeastern regional referral center.Am Surg 1995; 61: 767–772.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2004

Authors and Affiliations

  • Anindya Chattopadhyay
    • 2
    Email author
  • Rishab Dev Patra
    • 2
  • Vijaya Shenoy
    • 1
    • 2
  • Vijay Kumar
    • 2
  • Yoga Nagendhar
    • 2
  1. 1.Department of PediatricsKasturba Medical CollegeManipal, KarnatakaIndia
  2. 2.Department of Pediatric SurgeryKasturba Medical College, ManipalKarnatakaIndia

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