Postdural puncture headache with abdominal pain and diarrhea.
Dural puncture or a rent in the dura with prolonged cerebrospinal fluid leakage may cause noninfectious arachnoiditis and may be associated with urinary and fecal incontinence. Visceral dysfunction is common for patients with noninfectious arachnoiditis of the lumbosacral nerve roots after dural puncture. We report a case of postdural puncture headache associated with abdominal pain and diarrhea. An epidural blood patch was performed, and all symptoms resolved after 5 days. After exclusion of organic and psychological disorders, this treatment might be considered for patients who are experiencing abdominal pain and diarrhea after dural puncture.
Yang
Chih-Ping
CP
*Division of Anesthesiology, Armed Forces Taoyuan General Hospital; Departments of †Anesthesiology and ‡Orthopaedic Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China; and §Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Lee
Chian-Her
CH
Borel
Cecil O
CO
Yeh
Chun-Chang
CC
Lu
Chueng-He
CH
Wong
Chih-Shung
CS
Wu
Ching-Tang
CT
D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D017217:Blood Patch, Epidural; D003967:Diarrhea / Q000209:etiology*; D006261:Headache / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male
Hyderally H. Complications of spinal anesthesia. Mt Sinai J Med 2002;69:55–6.
Mardirosoff C, Dumont L. Bowel and bladder dysfunction after spinal bupivacaine. Anesthesiology 2001;95:1306.
Errando CL, Peiro C. Another explanation for bowel and bladder dysfunction after spinal bupivacaine. Anesthesiology 2002;97:524–5.
Aldrete JA. Neurologic deficits and arachnoiditis following neuroaxial anesthesia. Acta Anaesthesiol Scand 2003;47:3–12.
Avidan A, Gomori M, Davidson E. Nerve root inflammation demonstrated by magnetic resonance imaging in a patient with transient neurologic symptoms after intrathecal injection of lidocaine. Anesthesiology 2002;97:257–8.
Chiapparini L, Sghirlanzoni A, Pareyson D, Savoiardo M. Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases. Neuroradiology 2000;42:564–71.
Hannerz J, Ericson K, Bro Skejo HP. MR imaging with gadolinium in patients with and without post-lumbar puncture headache. Acta Radiol 1999;40:135–41.
Al-Chaer ED, Traub RJ. Biological basis of visceral pain: recent developments. Pain 2002;96:221–5.
Sarkar S, Hobson AR, Furlong PL, et al. Central neural mechanisms mediating human visceral hypersensitivity. Am J Physiol Gastrointest Liver Physiol 2001;281:G1196–202.
Traub RJ. Evidence for thoracolumbar spinal cord processing of inflammatory, but not acute colonic pain. Neuroreport 2000;11:2113–6.
Ji Y, Traub RJ. Spinal NMDA receptors contribute to neuronal processing of acute noxious and nonnoxious colorectal stimulation in the rat. J Neurophysiol 2001;86:1783–91.
Mayer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994;107:271–93.
Hyland JM, Butterworth J. Severe acute visceral pain from varicella zoster virus. Anesth Analg 2003;97:1117–8.
Di Giovanni AJ, Galbert MW, Wahle WM. Epidural injection of autologous blood for postlumbar puncture headache. II. Additional clinical experiences and laboratory investigation. Anesth Analg 1972;51:226–32.
Luijckx GJ, De Jaegere T. Magnetic resonance imaging findings before and after treatment of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2001;71:411.
Owyang C. Irritable bowel syndrome. In: Braunwald EFA, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's principles of internal medicine. 15th ed. New York: McGraw-Hill, 2001:1692–5.
Mertz H, Morgan V, Tanner G, et al. Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. Gastroenterology 2000;118:842–8.