Zusammenfassung
Vorgestellt wird der Fall eines 63-jährigen männlichen Patienten, der bei ausgedehnten postoperativen Wundheilungsstörungen im Bereich der unteren Extremität nach primär frustraner medikamentöser Schmerztherapie durch wiederholte Epiduralkatheter behandelt wurde. Im Verlauf kam es bei fehlenden neurologischen Symptomen als Zufallsbefund zur Diagnosestellung eines ausgedehnten spinalen Epiduralabszesses. Nach Berücksichtigung des Alters, der bestehenden Risikofaktoren und entsprechender Einbeziehung der beteiligten Fachrichtungen zur interdisziplinären Beurteilung gelang eine erfolgreiche konservative Behandlung des Patienten. In unserem Beitrag schließen sich eine ausführliche Diskussion und ein Literaturvergleich an.
Abstract
This case report describes a 63-year-old male patient with considerably impaired postoperative wound healing in the region of the lower extremities. After initial drug therapy for the pain was ineffectual, the patient was treated repeatedly through an epidural catheter. In the further course, an extensive spinal epidural abscess was diagnosed as an incidental finding without neurological symptoms. After taking into consideration the patient’s age and the risk factors present as well as inclusion of the subspecialties involved for an interdisciplinary assessment, the patient was successfully treated with a conservative approach. Our contribution concludes with a detailed discussion and comparison of the literature.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Beland B, Prien T, Van Aken H (1997) Spinal and regional anesthesia in bacteremia. Anaesthesist 46(6): 536–547
Ben-David B, Rawa R (2002) Complications of neuraxial blockade. Anaesthesiol Clin North Am 20: 669–693
Chao D (2002 ) Spinal epidural abscess: a diagnostic challenge. Am Fam Phys 65: 7
Danner RL, Hartman BJ (1987) Update of spinal epidural abscesses: 35 cases and review of the literature. Rev Infect Dis 9: 265–274
Dysart RH, Balakrishnan V (1997) Conservative management of extradural abscess complicating spinal-extradural anaesthesia for Caesarean section. Br J Anaesth 78: 591–593
Grieve JP, Ashwood N, O’Neill KS, Moore AJ (2000) A retrospective study of surgical and conservative treatment for spinal extradural abscess. Eur Spine J 9: 67–71
Hanigan WC, Asner NG, Elwood PW (1990) Magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess. Surg Neurol 34(6): 408–413, Medline Abstract
Hlavin ML, Kaminski HJ, Ross JS, Ganz E (1990) Spinal epidural abscess: a ten-year perspective. Neurosurgery 27: 177–184
Holt HM, Anderson SS, Anderson O et al. (1995) Infections following epidural catheterization. J Hosp Infect 30: 253–260
Hunt JR, Rigor BM, Collins J (1977) The potential for contamination of continuous epidural catheters. Anesth Analg 56: 222–225
Kindler CH, Seeberger MD, Staender SE (1998) Epidural abscess complicating epidural anaesthesia and analgesia. An analysis of the literature. Acta Anaesthesiol Scand 42(6): 609–613
Kurokawa Y, Hashi K, Fujishige M et al. (1989) Spinal subdural empyema diagnosed by MRI and recovered by conservative treatment. No To Shinkei 41(5): 513–517
Michel H, Steffen P, Weichel T, Seeling W (1997) Epiduritis after long-term pain therapy with an epidural catheter – review of the literature with a current case report. Anaesthesiol Reanim 22(3): 69–79
Nussbaum ES, Rigamonti D, Standiford H et al. (1992) Spinal epidural abscess: a report of 40 cases and review. Surg Neurol 38: 225–231
Okano K, Kondo H, Tsuchiya R et al. (1999) Spinal epidural abscess associated with epidural catheterization: report of a case and a review of the literature. Jpn J Clin Oncol 29(1): 49–52
Rong KL, Chi JC, Lok MT, Sien TC (2002) Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of literature. Neurosurgery 51: 509–512
Scott DB, Hibbard BM (1990) Serious non-fatal complications associated with extradural block in obstetric practice. Br J Anaesth 64: 537–541
Siddiq F, Chowfin A, Tight R et al. (2004) Medical versus surgical management of spinal epidural abscess. Arch Intern Med 164: 2409–2412
Sorensen P (2003 ) Spinal epidural abscesses: conservative treatment for selected subgroups of patients. Br J Neurosurg 17(6): 513–518
Teman AJ (1992) Spinal epidural abscess. Early detection with gadolinium magnetic resonance imaging. Arch Neurol 49: 743–746
Wang JS, Fellows DG, Vakharia S et al. (1996) Epidural abscess – early magnetic resonance imaging detection and conservative therapy. Anesth Analg 82: 1069–1071
Wessling H, de las Heras P (2003) Cervicothoracolumbar spinal epidural abscess with tetraparesis. Good recovery after non-surgical treatment with antibiotics and dexamethasone. Case report and review of literature. Neurocirugia 14: 529–533
Wheeler D, Keiser P, Rigamonti D, Keay S (1992) Medical management of spinal epidural abscesses: case report and review. Clin Infect Dis 15: 22–27
Interessenkonflikt
Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Graf, G., Likar, R., Schalk, HV. et al. Spinaler Epiduralabszess nach rückenmarknaher Langzeitanalgesie. Schmerz 21, 68–72 (2007). https://doi.org/10.1007/s00482-006-0489-0
Issue Date:
DOI: https://doi.org/10.1007/s00482-006-0489-0