Compartment syndrome related to viper bite in children

Abstract

Background

Compartment syndrome is a major complication of viper bites and it is more common in children. The aim of our retrospective study was to describe the clinical characteristics of viper envenomation-related compartment syndrome in children admitted to the paediatric intensive care unit at Rabat Children’s Hospital.

Methods

The severity of envenomation was evaluated according to the international classification: grade 0 (fang marks, no local signs), grade 1 (local swelling, no general symptoms), grade 2 (extensive swelling of the limb and/or moderate general symptoms) and grade 3 (wide spread swelling reaching the trunk and/or severe general symptoms).

Results

Seven of the eighteen patients admitted for viper bites between January 2004 and December 2010 were included in this study. Following a median delay of 23 hours, pain and local swelling were the main symptoms observed. Compartment syndrome resulted from grade-2 (five cases) and grade-3 envenomation (two cases). Female gender (4/7), bites during the afternoon (7/7) and summer (4/7) as well as bites involving the lower limbs (5/7) characterized envenomation that resulted in compartment syndrome. The median duration of hospitalization was 7 days. Fasciotomy was performed in all cases. Antivenom treatment had not been given. One child died.

Conclusion

Compartment syndrome is a serious complication of grade-2 and grade-3 viper envenomation. Our analysis emphasizes the need for specific immunotherapy to be available in medical institutions located in areas with a high incidence of viper bites, like ours.