Delayed Onset of Subdural Hematoma following Epidural Catheter Breakage

Abstract

Study Design Case report. Objectives To describe a case of delayed-onset spinal hematoma following the breakage of a spinal epidural catheter. Methods The authors describe the clinical case review. Results A 64-year-old woman had undergone epidural anesthesia 18 years before she was referred to our hospital because of lower-back pain and lower neurologic deficit with leg pain. The clinical examination showed the presence of a fragment of an epidural catheter in the thoracolumbar canal, as assessed by computed tomography, and a spinal hematoma that compressed the spinal cord at the same spinal level, as assessed by magnetic resonance imaging. Surgical removal of the epidural catheter and decompression surgery were performed. The patient exhibited substantial clinical improvement 1 month after surgery; she achieved a steady gait without the need for a cane and had no leg pain. Conclusion This is the first report of delayed onset of spinal hematoma following the breakage of an epidural catheter. Generally, when the breakage of an epidural catheter occurs without symptoms, follow-up alone is recommended. However, because spinal hematoma might exhibit a late onset, the possibility of this complication should be considered when deciding whether to remove the catheter fragment. We believe that in our patient, there could be a relationship between the catheter fragment and subdural hematoma, and catheter breakage could have been a risk factor for the spinal hematoma.

Fracture of epidural catheter: A case report and review of literature

“…[ 12 ] One case report recently mentioned the development of delayed onset subdural hematoma following epidural catheter breakage after 18 years of its placement. [ 13 ] It is clear that all patients with broken epidural catheter should be closely followed up; surgical management is required for the symptomatic patients.…”

Broken Epidural Catheter: An Anesthesiologist’s Dilemma

“…Recently, Ishikawa et al reported a case of delayed onset of subdural hematoma (18 years) following epidural catheter breakage, exploring the possibility of a relationship between catheter fragment and subdural hematoma. Decompression surgery was done to relieve the patient of symptoms [9]. If the proximal end of the segment is located at or just beneath the skin such that it can be retrieved through a skin incision by gentle traction [10].…”

Management of accidental lumbar epidural catheter breakage in a 5‐month‐old infant

“…The potential complications include infections and the induction of a foreign body granulomatous reaction, which could lead to symptomatic manifestations. According to available literature, most cases are reported in adult patients, including cases of long‐term retention with late clinical onset 3 . Surgical extraction is described but it is questionable 4 .…”