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

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. © 2016 tchaou et al.