Advertisement

World Journal of Pediatrics

, 7:361 | Cite as

Surgery in management of snake envenomation in children

  • Suppawat Laohawiriyakamol
  • Surasak SangkhathatEmail author
  • Piyawan Chiengkriwate
  • Sakda Patrapinyokul
Brief Report

Abstract

Background

Snakebite is common in children especially in the developing countries. This study was undertaken to determine the role of surgery in the treatment of venomous snake bite in pediatric patients.

Methods

The clinical data of 58 pediatric patients aged 0–16 years who had been treated for venomous snakebite from January 1999 to December 2008 were analyzed.

Results

Of the 58 patients, 43 (74.6%) were male. Peak age incidence was around 2–3 years (28.8%). The majority of envenomations occurred in the summer and rainy seasons, especially in the latter, during flooding. The bites occurred during 6 pm to 12 pm in 27 patients (49.0%). The main bite site was the lower extremities in 49 patients (83.9%). The main species of the snake were Malayan pit viper (Calloselasma rhodostoma) in 28 patients (47.5%) and cobra (Ophiophagus hunnah or Naja spp.) in 21 patients (35.6%). Soft tissue necrosis occurred more in cobra bites (47.6%) than viper bites (3.6%). The most common organism identified in necrotic tissue was Morganella morgagnii. Four patients with cobra bite had respiratory failure that required ventilatory support. Compartment syndrome was suspected in 2 patients. Surgical intervention was necessary in 13 patients. Most procedures involved serial wound debridement, followed by skin grafting. One case needed a toe amputation because of necrosis. The average length of hospital stay in patients who needed surgical management was 18.8 days (range: 12.1–25.5 days). There were no mortalities.

Conclusions

Surgery plays an important role in the management of snakebite patients, especially for those with cobra bite with tissue necrosis.

Key words

children snakebite surgery 

References

  1. 1.
    Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, et al. Clinical predictors of in-hospital mortality in patients with snake bite: a retrospective study from a rural hospital in central India. Trop Med Int Health 2006;11:22–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J 2005;22:118–120.PubMedCrossRefGoogle Scholar
  3. 3.
    Chattopadhyay A, Patra RD, Shenoy V, Kumar V, Nagendhar Y. Surgical implications of snakebites. Indian J Pediatr 2004;71:397–399.PubMedCrossRefGoogle Scholar
  4. 4.
    Lopoo JB, Bealer JF, Mantor PC, Tuggle DW. Treating the snakebitten child in North America: a study of pit viper bites. J Pediatr Surg 1998;33:1593–1595.PubMedCrossRefGoogle Scholar
  5. 5.
    Viravan C, Looareesuwan S, Kosakarn W, Wuthiekanun V, McCarthy CJ, Stimson AF, et al. A national hospital-based survey of snakes responsible for bites in Thailand. Trans R Soc Trop Med Hyg 1992;86:100–106.PubMedCrossRefGoogle Scholar
  6. 6.
    Wongtongkam N, Wilde H, Sitthi-Amorn C, Ratanabanangkoon K. A study of 225 Malayan pit viper bites in Thailand. Mil Med 2005;170:342–348.PubMedGoogle Scholar
  7. 7.
    Wongtongkam N, Wilde H, Sitthi-Amorn C, Ratanabanangkoon K. A study of Thai cobra (Naja kaouthia) bites in Thailand. Mil Med 2005;170:336–341.PubMedGoogle Scholar
  8. 8.
    Warrell DA. WHO/SEARO guidelines for the clinical management of snake bites in the Southeast Asian region. Southeast Asian J Trop Med Public Health 1999;30:11–85.Google Scholar
  9. 9.
    Warrell DA. Treatment of bites by adders and exotic venomous snakes. BMJ 2005;331:1244–1247.PubMedCrossRefGoogle Scholar
  10. 10.
    Dumavibhat B. A study of epidemiology, risk factors and preventive measures against snake bites. J Med Assoc Thai 1997;80:547–556.PubMedGoogle Scholar
  11. 11.
    Wong OF, Lam TS, Fung HT, Choy CH. Five-year experience with Chinese cobra (Naja atra)-related injuries in two acute hospitals in Hong Kong. Hong Kong Med J 2010;16:36–43.PubMedGoogle Scholar
  12. 12.
    Pochanugool C, Wildde H, Bhanganada K, Chanhome L, Cox MJ, Chaiyabutr N, et al. Venomous snakebite in Thailand. II: Clinical experience. Mil Med 1998;163:318–323.PubMedGoogle Scholar
  13. 13.
    Johnson CA. Management of snakebite. Am Fam Physician 1991;44:174–180.PubMedGoogle Scholar
  14. 14.
    Glass TG Jr. Early debridement in pit viper bites. JAMA 1976;235:2513–2516.PubMedCrossRefGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Suppawat Laohawiriyakamol
    • 1
  • Surasak Sangkhathat
    • 1
    Email author
  • Piyawan Chiengkriwate
    • 1
  • Sakda Patrapinyokul
    • 1
  1. 1.Pediatric Surgery Unit, Department of Surgery, Faculty of MedicinePrince of Songkla UniversityHat Yai, SongkhlaThailand

Personalised recommendations