Compartment syndrome of upper limb following snake bite, a case report

Snakebites, recognized as a neglected tropical disease by the WHO, cause significant morbidity and mortality globally. Although antivenom is the primary treatment, managing complications like compartment syndrome (CS) and soft tissue necrosis remains challenging. This case report describes a 39-year-old woman who developed CS following a green pit viper bite and subsequent antivenom administration, necessitating a fasciotomy.

The patient sustained a bite to her right middle finger, receiving 10 vials of polyvalent anti-snake venom. The next day, she developed symptoms suggestive of CS, prompting an emergency fasciotomy. The procedure included volar and dorsal forearm releases, finger incisions, and compartment releases. She was discharged on day 20 with optimal hand function and instructed to continue physiotherapy.

Snake venom contains toxic peptides and proteases that cause local and systemic effects, with severity influenced by venom quantity, bite location, and timely intervention. Upper extremity bites, particularly to the hand, are prone to CS due to the region's vascularity and anatomy. Although CS after snakebites is rare, its symptoms can mimic local envenomation, requiring careful differentiation and urgent management to prevent permanent damage. Fasciotomy may be necessary if CS persists despite antivenom therapy, as demonstrated in our case.

Snakebites, particularly to the upper extremities, require careful monitoring for complications like CS. Timely diagnosis and fasciotomy are crucial to prevent limb loss and preserve function.