Schlipköter M, Grieser T, Forst H
Klinik für Anästhesie und operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Augsburg, Stenglinstr. 2, Augsburg, Deutschland.
Klinik für Diagnostische und interventionelle Radiologie und Neuroradiologie, Klinikum Augsburg, Augsburg, Deutschland.
Anaesthesist. 2017 Jul;66(7):506-510. doi: 10.1007/s00101-017-0312-6. Epub 2017 May 9.
We report an unusual complication following placement of a thoracic epidural catheter in a patient that had undergone surgery for pulmonary metastases of a malignant melanoma. The intra- and postoperative course was initially without complications. At 2 days, there was a small, conspicuous swelling above the site of epidural puncture, which was neither reddened nor painful. No neurological deficits were observed, and the patient explained that he had been aware of the swelling for more than 6 months; thus, the epidural catheter was not deemed to be responsible. After catheter removal on day 4, an apparently purulent fluid drained from the puncture site. Although the patient had not reported this in the initial medical examination, he now explained that this cutaneous process had been squeezed out by his wife several times before. We initially obtained an exudate by means of ultrasound-guided puncture, and two epidermal cysts were detected on subsequent magnetic resonance imaging (MRI). The epidural catheter had been placed through one of these epidermal cysts. After reassessing the medical files, we found the earlier reports of two positron emission tomographies in which two epidermoid cysts were described at the level of thoracic vertebra 5/6 and 6/7. Facklamia hominis was detected in the pure culture. To avoid bacterial infection, we treated the patient for 7 days with antibiotics. The clinical course was without further pathological findings.
我们报告了一例在接受恶性黑色素瘤肺转移手术的患者中放置胸段硬膜外导管后出现的罕见并发症。术中和术后初期均无并发症。术后第2天，硬膜外穿刺部位上方出现一个小的、明显的肿胀，既无发红也无疼痛。未观察到神经功能缺损，患者称他注意到这个肿胀已有6个多月；因此，硬膜外导管不被认为是病因。在第4天拔除导管后，穿刺部位流出明显的脓性液体。尽管患者在最初的体格检查中未提及此事，但他现在解释说，他妻子之前曾多次挤出这个皮肤肿物。我们最初通过超声引导穿刺获取了渗出液，随后的磁共振成像（MRI）检查发现了两个表皮样囊肿。硬膜外导管是通过其中一个表皮样囊肿置入的。重新查阅病历后，我们发现之前两份正电子发射断层扫描报告中描述在胸5/6和胸6/7水平有两个表皮样囊肿。在纯培养物中检测到人类法克勒菌。为避免细菌感染，我们用抗生素治疗该患者7天。临床病程未出现进一步的病理表现。
