Russell's viper envenomation induces rectus sheath haematoma

• Published in: Toxicon (Oxford) Vol. 224; p. 107037
• Main Authors: Senthilkumaran, Subramanian, Almeida, José R., Williams, Jarred, Salim, Anika, Williams, Harry F., Thirumalaikolundusubramanian, Ponniah, Patel, Ketan, Vaiyapuri, Sakthivel
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2023
• Subjects: Animals; Antivenins - therapeutic use; Computed tomographic imaging; Daboia; Daboia russelii; Fothergill and carnett signs; Neurotoxicity Syndromes - drug therapy; Rectus sheath haematoma; Russell's viper; Snake Bites - drug therapy; Snakebite envenomation; Viper Venoms; Daboia russelii; Russell's viper; Fothergill and carnett signs; Snakebite envenomation; Rectus sheath haematoma; Computed tomographic imaging
• ISSN: 0041-0101; 1879-3150
• DOI: 10.1016/j.toxicon.2023.107037

Snakebite envenomation causes systemic and local manifestations, which result from the individual or synergistic actions of multiple venom components. The pathological hallmarks of medically important venomous snakes such as the Indian Russell's viper (Daboia russelii) are well known. Envenomation by Russell's viper is typically characterised by coagulopathies, muscular damage, nephrotoxicity, and neurotoxicity. However, recent reports have revealed several unusual complications that provide a better understanding of Russell's viper envenomation effects. To further strengthen this, here, we report a case of Russell's viper bite that induced acute abdominal pain, which was intensified on day two and conservatively treated under medical supervision. Both Fothergill and Carnett signs were positive for this patient. An ultrasound imaging revealed a dissimilar dense mass, and the abdominal computed tomography scan confirmed rectus sheath haematoma. The clinical management involved the administration of polyvalent antivenom, packed red blood cells, fresh frozen plasma, and platelets. The patient recovered gradually and was discharged from the hospital eight days after the bite. Overall, this case presentation shares an uncommon experience and adds new insights into the complex series of rare pathological events associated with Russell's viper bites in India. The scientific documentation of relatively infrequent entities based on an ongoing living assessment of medical experiences, for example, this rectus sheath haematoma, constitutes valuable guidance for an adequate diagnosis and timely treatment. Essential awareness among clinicians and further research on understanding the molecular relationship between Russell's viper venom and rectus sheath haematoma will improve patient outcomes and understanding of this condition, respectively. [Display omitted] •Severe abdominal pain was documented following Russell's viper envenomation.•Russell's viper bite-induced rectus sheath haematoma.•The diagnosis was achieved by physical examination and CT imaging.•Antivenom, packed red cells, fresh frozen plasma, and platelet transfusion were used to treat.•Healthcare professionals should be aware of this condition in snakebite victims.