title: Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation.
abstract: BACKGROUND
  In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation.
  
  
  METHODS
  An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou.
  
  
  RESULTS
  The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %.
  
  
  CONCLUSIONS
  Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.
authors.affiliation: Centre Hospitalier Universitaire et Départemental du Borgou/Alibori, Parakou, Bénin.
authors.forename: Blaise Adelin
authors.initials: BA
authors.lastname: Tchaou
authors.affiliation: Centre Hospitalier Universitaire et Départemental du Borgou/Alibori, Parakou, Bénin.
authors.forename: Kofi-Mensa
authors.initials: KM
authors.lastname: Savi de Tové
authors.affiliation: Centre d'Étude et de Recherche sur le Paludisme Associé à la Mère et à l'Enfant, Cotonou, Bénin.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Sissinto-Savi de Tové
authors.affiliation: Centre Hospitalier Universitaire et Départemental du Borgou/Alibori, Parakou, Bénin.
authors.forename: Aurélien Tchémaha C
authors.initials: AT
authors.lastname: Djomga
authors.affiliation: Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Bénin.
authors.forename: Abdou-Rahman
authors.initials: AR
authors.lastname: Aguemon
authors.affiliation: Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Bénin.
authors.forename: Achille
authors.initials: A
authors.lastname: Massougbodji
authors.affiliation: UMR 216, Mère et enfant face aux infections tropicales, Institut de Recherche pour le Développement, Cotonou, Bénin ; Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Chippaux
keywords: Envenomation; Hematoma; Hemoperitoneum; Internal bleeding; Ultrasound