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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases.Indian Pediatr 1994; 31: 1239–1242.
Pillay VV. Bites and stings. InHandbook of Forensic Medicine and Toxicology, 12th edn. Bangalore, Paras Medical Publishers, 2001; 345–350.
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.
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.
Wilkinson D. Retrospective analysis of snakebite at a rural hospital in Zululand.S Afr Med J 1994; 84: 844–847.
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.
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.
Tokish JT, Benjamin J, Walker F. Crotalid envenomation: the southern Arizona experience.J Orthop Trauma 2001; 15: 5–9.
Weber RA, White RR. Crotalidae envenomation in children.Ann Plast Surg 1993; 31: 141–145.
Glass TG Jr. Early debridement in pit viper bites.JAMA 1976; 235: 2513–2516.
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.
Forks TP. Evaluation and treatment of poisonous snakebites.Am Fam Physician 1994; 50: 123–130.
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.
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.
Rudolph R, Neal GE, Williams JS, McMohan AP. Snakebite treatment at a southeastern regional referral center.Am Surg 1995; 61: 767–772.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chattopadhyay, A., Dev Patra, R., Shenoy, V. et al. Surgical implications of snakebites. Indian J Pediatr 71, 397–399 (2004). https://doi.org/10.1007/BF02725623
Issue Date:
DOI: https://doi.org/10.1007/BF02725623