Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation

• Published in: Journal of Venomous Animals and Toxins including Tropical Diseases
• Main Authors: Blaise Adelin Tchaou, Kofi-Mensa Savi de Tové, Yolande Sissinto-Savi de Tové, Aurélien Tchémaha C. Djomga, Abdou-Rahman Aguemon, Achille Massougbodji, Jean-Philippe Chippaux
• Format: Article in Journal/Newspaper
• Language: English
• Published: SciELO 2016
• Subjects: Envenomation; Ultrasound; Internal bleeding; Hemoperitoneum; Hematoma; Arctic medicine. Tropical medicine; RC955-962; Toxicology. Poisons; RA1190-1270; Zoology; QL1-991; Arctic
• Online Access: https://doi.org/10.1186/s40409-016-0063-x; https://doaj.org/article/92ae06ea6a7341fe9229ec26b918d6e0

Abstract Background In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. Methods An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. Results The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. Conclusion Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.