Superior Mesenteric Artery Thrombosis Following a Snakebite: A Rare Case

Snakebites are common emergencies in tropical countries, usually presenting with hematotoxic, neurotoxic, or myotoxic effects. Vascular thrombosis as a systemic complication is extremely rare. We report a case of superior mesenteric artery (SMA) thrombosis following a viper bite, leading to acute mesenteric ischemia. A 39-year-old male patient presented with abdominal pain, vomiting, loose stools, and reduced urine output following a snakebite with Daboia russelii to the right index finger. He had received 20 vials of anti-snake venom at a peripheral hospital. On examination, he was tachycardic with abdominal distension, diffuse tenderness, guarding, and rigidity. Blood investigations suggested leukocytosis, thrombocytopenia, and elevated creatinine levels. Imaging revealed dilated small bowel loops and near-complete thrombosis of the jejunal and ileal branches of the SMA. The patient underwent exploratory laparotomy, with resection of gangrenous small bowel, with double-barrel stoma. Despite emergent surgical intervention and intensive supportive care, the patient’s condition deteriorated rapidly. The patient succumbed to multi-organ failure and died on postoperative day two. This case highlights the rare but lethal complication of acute mesenteric ischemia following viper envenomation. Early recognition and timely surgical intervention are critical for favorable outcomes.