Compartment syndrome of arm secondary to snake bite on hand: a case report

Snake bites pose a significant common public health concern, with more prevalence in rural areas. Compartment syndrome (CS) is one of the rare and severe manifestations of snake bite wherein venom-induced swelling within a closed anatomical compartment leads to increased pressure which may result in ischemic damage to nerves and muscle. Anti-snake venom and prompt fasciotomy is recommended for management of CS secondary to snake bite. Here we report a case of 47 years female with Green Pit Viper bite on the left hand. Upon arrival to hospital, initial resuscitation measures were initiated. Six hours following the bite, there was severe pain on passive stretch and paresthesia. Ten vials of Anti-snake venom (ASV) administration along with fasciotomy of hand and arm resulted in notable alleviation of pain and swelling. Eighteen pint of blood was transfused for coagulopathy and low hemoglobin. After continued care of wound and intensive physiotherapy, functional limb could be achieved. Snakebite envenomation is one of the biggest hidden health crises with case fatality rate of 7.8% in the southern plains of Nepal. As in our case, snake bites commonly affect upper extremities, accounting for around two third of all cases. Compartment syndrome must be differentiated from acute swelling, which sometimes may be difficult. Surgical decompression is indicated in presence of signs and symptoms of compartment syndrome, in case of resource limited setting. Multidisciplinary and prompt management with initial resuscitation, ASV administration, fasciotomy, and rehabilitative measures can save both life and limb in such cases.