Unrecognized Durotomy Resulting in High Volume Cerebrospinal Fluid Diversion Through a Hemovac®.

BACKGROUND

The purpose of this study was to highlight the clinical features of spider bite envenomation, a subject which has not, to our knowledge, been previously published in Saudi Arabia.

PATIENTS AND

METHODS

Ten patients (8 males and 2 females) aged between 13 and 75 years (mean 36.8) were hospitalized at King Fahad Hospital, Al Baha, with the diagnosis of spider bites during the 9-year period from June 1988 to May 1997.

RESULTS

One of the patients was bitten on the right hand by a brown spider, causing severe cellulitis and tissue necrosis, and requiring surgical debridement and pedicle skin flap graft. The nine other patients (90%) had bites from black spiders identified as black widow spiders. Two of the nine (22.2%) suffered only local reactions in the form of pain, erythema and swelling at the site of bite. The remaining seven (77.8%), had varying symptoms of systemic envenomation, including pulmonary edema, myocardial dysfunction with elevated creatinine kinase, electrocardiographic and echocardiographic abnormalities, progressive paresthesia, generalized body ache, etc. Therapy included analgesics, muscle relaxants, intravenous infusion of calcium gluconate and oxygen where indicated. Specific antivenin therapy was available for only four of the nine patients (44%) with black widow spider bite. Antivenin therapy still produced dramatic relief of the symptoms in the patient with pulmonary edema, even after a delay of 30 hours.

CONCLUSION

Spider bite envenomation should be considered in the differential diagnosis of acute surgical abdomen and myocardial infarction.