Hemoperitoneum after a Bothrops snakebite: Case report

• Published in: Toxicon (Oxford) 2024-01, Vol.237, p.107350, Article 107350
• Main Authors: Abad Ribeiro, Adriana Baqueiro, Santoro, Marcelo Larami, Duarte, Marcelo Ribeiro, Virgulino, Cristiana Cruz, de Oliveira, Gerson Sobrinho Salvador, França, Francisco Oscar de Siqueira
• Format: Article
• Language: English
• Subjects: Bothrops envenomation; Case report; Hemoperitoneum; Peritoneal hemorrhage; Snakebite
• ISSN: 0041-0101; 1879-3150
• DOI: 10.1016/j.toxicon.2023.107350

Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70–90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites. •Description of a life-threatening case of envenomation by a juvenile Bothrops jararaca snake.•The patient presented coagulopathy, extensive peritoneal hemorrhage followed by hypotension/shock, and acute kidney injury.•Hemoperitoneum was suspected because the patient presented vomiting, abdominal pain, hypotension and acute anemia.•Computed tomography was essential for diagnostic confirmation and monitoring the evolution of hemoperitoneum.•Hemoperitoneum is a rare and a potentially fatal cause of systemic hemorrhage in snakebites.