Acute compartment syndrome following Bitis viper envenomation: a literature review with case reports

Snakebites caused by Bitis nasicornis and Bitis gabonica are rare but can lead to severe systemic and local complications, including acute compartment syndrome (ACS). The role of surgical intervention in snakebite management remains controversial, with limited data available for snakebite envenomation.

Two cases of upper limb envenomation by Bitis nasicornis and Bitis gabonica were managed at the General University Hospital in Prague in year 2024. Both developed acute compartment syndrome requiring prompt antivenom therapy, fasciotomy, and intensive care. In the first case, antivenom (EchiTab-Plus-ICP) was given within 1 h, 10 vials in total, and fasciotomy at 10 h; the patient was discharged on day 16 with preserved limb function. In the second, antivenom (SAIMR) was administered within 3 h, 4 vials in total (the maximum available in Europe at that time), and fasciotomy at 8 h; recovery was complete by day 7. Diagnosis of ACS was based on clinical signs without intracompartmental pressure measurement.

These cases highlight that timely surgical intervention, combined with intensive care and antivenin may play a critical role in preventing irreversible tissue damage following viperid envenomation. However, universal guidelines are lacking. Incorporating intracompartmental pressure monitoring into treatment protocols may further improve diagnostic accuracy and patient outcomes.