Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2021; 9(26): 7857-7862
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7857
Critical lower extremity ischemia after snakebite: A case report
Zi-Ying Lu, Xiao-Dong Wang, Jin Yan, Xiao-Long Ni, Si-Pin Hu
Zi-Ying Lu, Xiao-Dong Wang, Jin Yan, Xiao-Long Ni, Si-Pin Hu, Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
Author contributions: Lu ZY and Wang XD were the patient’s surgeons, reviewed the literature, and contributed to the drafting of the manuscript; Yan J reviewed the literature and contributed to the drafting of the manuscript; Ni XL analyzed and interpreted the imaging findings; Hu SP reviewed the literature and drafted the manuscript; all authors issued final approval for the version to be submitted.
Supported by the 13th FIVE-YEAR Key Project for Traditional Chinese Medicine of Zhejiang Province, No. 2A11951; Basic Public Welfare Research Program of Zhejiang Province, No. LGF21H020002; Clinical Research Fund of Zhejiang Medical Association, No. 2020ZYC-A03; and Traditional Chinese Medicine Scientific Research Fund Project of Zhejiang Province, No. 2021ZA038.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to those criteria.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Dong Wang, MD, Chief Doctor, Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Hangzhou 310000, Zhejiang Province, China. hzsparks@hotmail.com
Received: March 30, 2021
Peer-review started: March 30, 2021
First decision: June 7, 2021
Revised: June 8, 2021
Accepted: July 30, 2021
Article in press: July 30, 2021
Published online: September 16, 2021
Abstract
BACKGROUND

Globally, the estimated annual incidence of snakebites is approximately 5 million, and approximately 100000 deaths occur from snakebites annually. Local tissue reaction, haemorrhagic clotting disorder, nephrotoxicity, and neurotoxicity are very common effects of snake envenomation, but other rarer complications, such as thrombosis, may also occur as a result of underlying disease. In the treatment of snakebite patients, attention should be paid to the patient’s underlying diseases to avoid serious and catastrophic consequences secondary to snakebite.

CASE SUMMARY

We report a 69-year-old man with critical right lower extremity pain after left foot snakebite 10 d prior without intermittent claudication or atrial fibrillation history. He was diagnosed with acute right lower extremity arterial thrombosis, which may have been caused by coagulopathy after snakebite and lower extremity atherosclerotic occlusive disease. Lower extremity computed tomography angiography at another hospital revealed that the aortoiliac and femoral arteries had neither filling defects nor atherosclerosis, but the right popliteal artery was occluded 2.3 cm below the tibial plateau. The patient received emergency catheter-directed thrombolysis, but amputation was carried out 11 d after admission because the patient had been admitted to the hospital too late to save the extremity.

CONCLUSION

Acute ischaemia of the lower extremity due to snakebite is a rare event, and physicians should bear in mind the serious complications that may occur, especially in patients with atherosclerotic disease.

Keywords: Critical extremity ischaemia, Snakebite, Thrombosis, Haematological abnormalities, Case Report

Core Tip: We report a 69-year-old man who presented with critical right lower extremity pain and was diagnosed with acute right lower extremity arterial thrombosis that may be caused by coagulopathy after snakebite and arteriosclerosis in lower extremity. Haematological abnormalities are very common with snakebites, but thrombotic manifestations are less common. Physicians should bear in mind the rare complications and devastating sequela of extremity ischemia following snakebite, especially for patients with atherosclerotic disease.