HAEMOPERITONEUM SECONDARY TO SNAKE BITE.

BACKGROUND

Literature supports that very rarely the venom of "Hemotoxic Snake" (Russell's Vipers) affect haemostasis by secreting thrombin-like enzyme which promotes formation of unstable clots. Such clots could lead to fibrin deposition in micro circulation that in turn consume platelets and coagulation factors (consumption coagulopathy). Clinical presentation is mainly spontaneous bleeding and coagulopathy. In this case the significant effects of altered coagulation were observed in retropetitoneum and the patient presented in casuality as acute abdomen.

METHODS

A 17-years-old boy presented to a tertiary care hospital, complaining of abdominal pain for 5 days and fatigue. He gave a history of snake bite 10 days prior. In order to seek immediate medical care, he went to the community hospital where antivenom was given. Upon examination he was vitally stable. Abdomen was found distended and severely tender. On workup after admission he was found to be anaemic (Hb: 6 g/dl), and damaged clothing profile (PT: 19.5 and INR: 1.7). CT scan showed collection of 7x6.6 cm in right paracolic and right lumbar region, just anterior to the psoas muscle. Active intra-abdominal bleeding and few organised hematomas were also appreciated. Prior to the specific management, patient was optimised with PCVS and FFPS. After 28 hours he was explored under G/A. Perioperatively about 1100 ml of blood was evacuated from the peritoneal cavity. Multiple hematomas were drained from retroperitoneum (Zone II), on right side. No active bleeding was noticed from IVC and aorta. Packing done and drains placed. Re-exploration was done after 72 hours. Packs removed and further hemostasis was augmented with fibrillar and gelatin sponge.

CONCLUSIONS

He had steady recovery, with 14 days of hospital stay. One of the concerns in postoperative phase was bradycardia that compelled us to manage it with atropine.