[Case of epidural hematoma developed after extraction of the epidural catheter and heparin injection in a patient with pulmonary embolism after colectomy].
A 65-year-old man underwent transversal colectomy for colon cancer under combined epidural and general anesthesia. On the 1st postoperative day, he developed consciousness loss and low SpO2 (< 90%) after walking, and pulmonary embolism was diagnosed by CT-scan and pulmonary scintigraphy. His consciousness and hemodynamic state recovered, and anticoagulation therapy was started after extraction of the epidural catheter. Heparin 5000 units was injected and continuous injection was started. Five hours after the extraction of the catheter, he developed paraplegia and analgesia below L1, and epidural hematoma was found with magnetic resonance imaging (MRI). Emergent laminectomy was performed and the hematoma was removed. The day after laminectomy, injection of heparin was started and 1 g x day(-1) of methylpredonisolone administered for 3 days. His paraplegia did not improve after the laminectomy. We discussed about pulmonary embolism and epidural hematoma.
Endoh
Masahiro
M
Department of Anesthesia, National Cancer Center Hospital, Tokyo 104-0045.
Tanaka
Sinichiroh
S
Murakami
Satoshi
S
Kadota
Waki
W
Shimoyama
Naohito
N
D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000768:Anesthesia, General; D002404:Catheterization / Q000009:adverse effects*; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007796:Laminectomy; D008297:Male; D010264:Paraplegia / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications; D011655:Pulmonary Embolism; D017211:Treatment Failure
D006493:Heparin