Continuous Epidural Catheter for Anaesthesia Management and Post-Op Pain Relief in Colorectal Surgery, Complicated by Epidural Haematoma and Bilateral Paraplegia: A Case Report Publisher



Ashouri M¹ ; Karvandian K² ; Ataieashtiani Z³ ; Mohammadzadeh N¹ Show Affiliations
Source: International Journal of Surgery Case Reports Published:2021

Abstract

Introduction: Utilising epidural analgesia (EA) during major abdominal surgery in combination with general anaesthetic, is a proven approach to decrease anaesthetic requirement in patients with severe comorbidities, enhance recovery and improve pain management. Case presentation: Herein we report a case of an 81-years-old female with bilateral lower limb sensory loss, saddle paraesthesia, paraplegia, and incontinence following a thoracic epidural catheterisation required for low anterior resection of rectal adenocarcinoma. The complication was reported by the patient on the third day of post-op. Clinical discussion: The magnetic resonance imaging results revealed an extradural extramedullary hyperintense haematoma in the spinal cord at T12-L2 vertebral level. The neurological deficit was addressed urgently with laminectomy; and following implementation of intensive inpatient physiotherapy and rehabilitation regiment the patient restored mild motor function. Conclusion: We believe the culprit of the acute focal neurology deficits in this patient could be due to the epidural catheterisation and the post-op local anaesthetic injections. From this case, we anecdotally recommend performing thoracolumbar MRI as part of pre-op workup in patients with long standing back issues or claudication, considering x-ray guided catheterisation in higher risk patients for epidural hematoma, and early and repeated neurological examination and rapid investigation for any mild neurological deficits. © 2021