SPINAL EPIDURAL ABSCESS FOLLOWING EPIDURAL ANALGESIA IN AN OBSTETRIC PATIENT: REPORT OF A RARE CASE
Dr. Atilla Kazanci
5 slide(s) – English – 2011-09-08
Background and aims: Epidural analgesia has gained increased application in obstetric patients. Epidural abscess is a rare but potentially serious complication of epidural anesthesia with an overall incidence of 0.2 to 2 per 10,000 hospital admissions per year and may cause significant disability if not diagnosed and treated promptly.
Methods: A 33-year-old woman was admitted to our department with back pain and difficulty standing upright. Past medical history included a recent caserean section (C/S) with epidural analgesia. Further questioning revealed that she was discharged on the second post partum day with the epidural catheter in situ. Four days later, the catheter was removed intact at home by the anesthetist.
Six weeks after delivery she noticed difficulty in climbing stairs and standing up with increasing back pain. CRP and ESR were significantly elevated. Magnetic resonance (MR) scan showed an epidural abscess at T11-T12 levels (Fig 1a). The patient underwent emergency laminectomy and the abscess was drained. The cultures grew Staphylococcus aureus. Postoperative MR confirmed decompression of cord (Fig 1b). The organism was sensitive to cefuroxime and she was treated first with IV and then with PO cefuroxime.
Results and conclusions: Spinal epidural abscess is a rare but serious complication of epidural anesthesia and analgesia. Timely surgical decompression and long-term antibiotic therapy is the only appropriate treatment.
Fig 1a,1b: preoperative and postoperative MRI findings: Note T11-T12 interspace level epidural abscess in 1a and decompression after surgery in 1b.