[Epidural hematoma associated with epidural catheterization in a cirrhotic patient].
We present a case of epidural hematoma in a liver cirrhosis patient with a depressed platelet count but normal prothrombin and activated thromboplastin times. A 60-year-old woman hospitalized with liver cirrhosis was referred to us for low back pain. She suffered the fracture of the body of the 12 th thoracic vertebra in a fall. Her platelet count was below normal ranges, but, other coagulation tests were within normal ranges. We inserted an 18-gauge epidural catheter at Th 12-L1 interspace. Twenty-one days later, paresis and hypesthesia in both legs, and a loss of sphincter function occurred. Magnetic resonance imaging revealed a posteriorly placed hematoma extending from Th 12 to L1. Considering the hemorrhagic tendency and hepatic insufficiency, we did not perform laminectomy. After 4 days, the patient's strength began to recover, and after 7 days paresis and hypesthesia improved. We should avoid performing epidural catheterization to improve chronic pain for a patient with liver cirrhosis if his or her platelet count is below 100,000.mm-3.
Tamakawa
S
S
Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical College.
Ogawa
H
H
D015360:Analgesia, Epidural / Q000009:adverse effects*; D001416:Back Pain / Q000209:etiology / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects*; D000075202:Contraindications; D004824:Epidural Space; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D010976:Platelet Count; D016103:Spinal Fractures / Q000150:complications; D013904:Thoracic Vertebrae / Q000293:injuries; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications