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



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.


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.


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.


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 


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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

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