A case report of a patient with ankylosing spondylitis undergoing major abdominal surgery who developed a spinal epidural haematoma postoperatively.
A 67 yr old male, with a background history significant for ankylosing spondylitis, and ischemic heart disease was scheduled for elective open repair of a 7cm Juxta-renal abdominal aortic aneursym.
Rationale for epidural was majour surgery and presence of restrective lung disease. Factors which could contribute to development of haematoma could be his medications including aspirin, deltacortil and diclofenac and renal impairment.
Epidural catheter was sited atraumatically and uneventfully. Anticoagulation was done with strict adherence to ESRA guidelines.
Postoperatively the epidural catheter became dislodged .On day 5 left leg neurological deficit was noted. An Emergency MRI spine revealed a T12-L3 epidural haematoma for which the patient underwent emergency decompressive laminectomy with evacuation of a haematoma. He was discharged home 12 days post open AAA repair without neurological sequel.
Conclusion; Ankylosing spondylitis is a significant risk factor for the development of SEDH following neuroaxial techniques.Despite adhering to ASRA anticoagulation guidelines, patient developed a SEDH.
A high index of suspicion is necessary to avoid delayed diagnosis and adverse neurologic outcomes in a patient with multiple risk factors , increased age, spinal canal stenosis, NSAIDs, renal impairment, anticoagulation.
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