A Case Report of Epidural Hematoma after Partial Liver Resection

Abstract

Epidural hematoma is an extremely rare but serious complication of epidural anesthesia. The time between the onset of paraplegia to surgery is critically important for determining the neurologic outcomes of the patients. This is a case report of epidural hematoma that developed after the removal of an epidural catheter in a patient who underwent a partial liver resection. Because a subdermal hematoma was noted at the insertion point of the epidural catheter upon admission to the intensive care unit (ICU) after the surgery, the epidural catheter was removed to stop continuous subdermal bleeding. The platelet count at that time had decreased to 64,000/μl and prothrombin time was prolonged to 53% in activity. Ten hours later, the patient complained of paraplegia in both lower extremities which the ICU doctor on duty attributed to persistent epidural anesthesia. Given that neurologic abnormalities persisted for four hours, an emergency MRI was performed that revealed a posteriorly-placed epidural hematoma extending from T6-T11. Despite emergency laminectomy, the neurologic outcome was poor. This case report highlights the importance of recognizing the potential risks of epidural hematoma following epidural catheter placement and the need for prior communication with anesthesiologists in case clinical coagulopathy occurs.