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

 

Blaise Adelin Tchaou¹, Kofi-Mensa Savi de Tové¹, Yolande Sissinto-Savi de Tové², Aurélien Tchémaha C. Djomga¹, Abdou-Rahman Aguemon³, Achille Massougbodji³, Jean-Philippe Chippaux^{4 5}

 

1 Centre Hospitalier Universitaire et Départemental du Borgou/Alibori, Parakou, Bénin.

2 Centre d'Étude et de Recherche sur le Paludisme Associé à la Mère et à l'Enfant, Cotonou, Bénin.

3 Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Bénin.

4 UMR 216, Mère et enfant face aux infections tropicales, Institut de Recherche pour le Développement, Cotonou, Bénin.

5 Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.

 

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.

 

Key words: Envenomation; Ultrasound; Internal bleeding; Hemoperitoneum; Hematoma

 

Funding

This study was funded by the University Hospital of Parakou, Benin.

 

Received: August 29, 2015.

Revised: February 19, 2016.

Accepted: March 16, 2016.

 

Correspondence: tchblaise@yahoo.fr

 

Competing interests

The authors declare that there are no competing interests.

 

Authors' contributions

All authors conceived the report and participated in its design. BAT, SST, ADT, and ARA performed the diagnosis, ultrasonography and treatment of patients, JPC drafted the manuscript. All authors read and approved the final manuscript.

 

doi:.10.1186/s40409-016-0063-x