Dam-Hieu Phong, Rodriguez Victor, De Cazes Yannick, Quinio Bertrand
Départements d'Anesthésiologie, Neurochirurgie et Unité d'Evaluation et de Traitement de la Douleur, Centre Hospitalier Universitaire, Brest, France.
Reg Anesth Pain Med. 2002 Sep-Oct;27(5):517-9.
Knotting and looping of catheters in the epidural space occur rarely. Visualization of a catheter by radiograph or fluoroscopy is not always possible and often inaccurate in locating the knot and/or the loop with precision. We report the case of an entrapped lumbar epidural catheter. Computed tomography (CT) clearly showed a knotted and looped catheter.
A 27-year-old woman underwent epidural analgesia during labor. The epidural catheter was inserted 7 cm into the epidural space. After unsuccessful attempts at removing the catheter, a CT scan was performed, and it showed a catheter knot in the epidural space as well as a loop within the interlaminar ligamentum flavum between L3 and L4. This explained why attempts to remove the catheter by manual traction failed. Surgical removal of the catheter was subsequently performed.
CT is useful in showing an entrapped epidural catheter and the mechanisms of entrapment. Surgery should be considered when gentle traction fails to retrieve the catheter. CT allows the clinician to localize the catheter with accuracy, thus facilitating surgical follow-up.
硬膜外间隙导管打结和形成袢的情况很少见。通过X线片或荧光透视来观察导管并不总是可行的，而且在精确确定结和/或袢的位置时常常不准确。我们报告一例腰椎硬膜外导管陷入的病例。计算机断层扫描（CT）清晰显示了一根打结并形成袢的导管。
一名27岁女性在分娩期间接受硬膜外镇痛。硬膜外导管插入硬膜外间隙7厘米。在尝试拔出导管失败后，进行了CT扫描，结果显示硬膜外间隙有一个导管结，以及L3和L4之间的黄韧带层间有一个袢。这解释了为什么通过手动牵引拔出导管的尝试失败。随后进行了导管的手术取出。
CT有助于显示陷入的硬膜外导管及其陷入机制。当轻柔牵引无法取出导管时，应考虑手术。CT使临床医生能够准确地定位导管，从而便于手术后续操作。
