Pinciroli Riccardo, Fumagalli Roberto
Department of Anesthesia and Critical Care, Anesthesia and Critical Care Service 1, Niguarda Cà Granda Hospital, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy.
Department of Health Sciences, University of Milan-Bicocca, Monza, Italy.
BMC Anesthesiol. 2015 Jun 4;15:83. doi: 10.1186/s12871-015-0062-4.
We report the peculiar case of a patient with a retained large epidural catheter fragment, incidentally found 12 years after its placement. Our primary aim is to emphasize how the breakage and retention of even exceptionally large portions of this device can go undetected. The patient can be completely asymptomatic and, with no clue that such a foreign body exists, the presentation of its potential complications can be subtle and misleading. To our knowledge, this is the first reported case of the incidental discovery of such a large fragment so many years after its placement. No consensus exists about how to handle this complication, therefore our report adds to the amount of available evidence.
A 53-year-old caucasian female with a history of diverticulitis requiring multiple hospitalizations underwent laparoscopic sigmoidectomy. The early postoperative period was complicated by peritonitis, demanding an urgent "second-look" exploratory laparoscopy. Nine days post-operatively, a filiform metallic object in the upper-quadrant was noted on x-ray. No epidural had been placed for either one of her recent surgeries. Given the patient's history, the object was initially thought to be a retained surgical sponge. Previous studies, however, showed that the same image was already present preoperatively. Upon further questioning, the patient reported an epidural being placed twelve years before, at the time of her pregnancy. No mention of breakage had been made to her at that time, nor a retained foreign body was ever reported afterwards, despite her many imaging exams. She also never experienced any symptoms. A 15 cm fragment of a wire-reinforced catheter was surgically retrieved under local anesthesia and fluoroscopic guidance.
Breakage of the epidural catheter with fragment retention is a known complication of this device, possibly leading to devastating sequelae. The fragment can go undetected for years. In this case our finding was incidental and the patient was asymptomatic. However, in the event a neurologic complication arose, the identification of the unknowingly retained epidural as the causative agent could have been difficult and delayed, with potential harm to the patient.
我们报告了一例特殊病例，一名患者在硬膜外导管置入12年后意外发现有一大段导管碎片残留。我们的主要目的是强调，即使是该装置非常大的部分发生断裂和残留，也可能未被发现。患者可能完全没有症状，而且在没有任何迹象表明存在这种异物的情况下，其潜在并发症的表现可能很微妙且具有误导性。据我们所知，这是首次报道在导管置入多年后意外发现如此大的碎片的病例。对于如何处理这种并发症尚无共识，因此我们的报告增加了现有证据的数量。
一名53岁有憩室炎病史且多次住院的白种女性接受了腹腔镜乙状结肠切除术。术后早期出现腹膜炎并发症，需要紧急进行“二次探查”腹腔镜检查。术后九天，X线检查发现上腹部有一个丝状金属物体。她近期的两次手术均未置入硬膜外导管。鉴于患者的病史，该物体最初被认为是一块残留的手术海绵。然而，先前的研究表明，术前就已存在相同的影像。进一步询问后，患者报告称在其怀孕时曾于12年前置入过硬膜外导管。当时未提及导管断裂情况，此后尽管她接受了多次影像学检查，但也从未报告有异物残留。她也从未出现过任何症状。在局部麻醉和荧光镜引导下，手术取出了一段15厘米长的带钢丝加强的导管碎片。
硬膜外导管断裂并残留碎片是该装置已知的一种并发症，可能导致严重后果。碎片可能多年未被发现。在本病例中，我们的发现是偶然的，且患者无症状。然而，如果出现神经并发症，要确定无意中残留的硬膜外导管为病因可能会很困难且延迟，从而可能对患者造成伤害。
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