Case 34: Delayed Cutaneous Fluid Leak from a Puncture Hole After Removal of an Epidural Catheter

  • John G. Brock-Utne


You are called after hours to evaluate clear liquid leaking from an “epidural catheter puncture hole.” The patient is a 50-year-old Asian male (ASA 2) who had an exploratory laparotomy with gastrostomy for gastric cancer 5 days previously. He had an epidural catheter through which epidural hydromorphone had been used until the second postoperative day, when it was removed intact. The patient is sitting up in bed and not complaining of anything, not even a headache. His past history and examination are noncontributory.


Epidural Cerebrospinal fluid CSF CSF leak Subcutaneous edema Interstitial fluid Laparotomy Epidural catheter General anesthesia 


  1. 1.
    Ennis M, Brock-Utne JG. Delayed cutaneous fluid leak from the puncture hole after removal of an epidural catheter. Anaesthesia. 1993;48:317–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Vanner RG. Acetylcholinesterase – a specific marker for cerebrospinal fluid. Anaesthesia. 1988;43:299–300.CrossRefPubMedGoogle Scholar
  3. 3.
    Jawalekar SR, Marx GF. Cutaneous cerebrospinal fluid leakage following attempted extradural block. Anesthesiology. 1981;54:348–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Morparia HK, Vontivillu J. Case report: Cerebrospinal fluid fistula – a rare complication of myelgraphy. Clin Radiol. 1991;44:205.CrossRefPubMedGoogle Scholar
  5. 5.
    Chan BO, Paech MJ. Persistent cerebrospinal fluid leak: a complication of the combined spinal-epidural technique. Anesth Analg. 2004;98:828–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Bansal S. Fluid leak from epidural puncture site: a diagnostic dilemma. Anesth Analg. 2004;99:1577.CrossRefPubMedGoogle Scholar
  7. 7.
    Downey L, Slater EM, Zeitlin GL. Differentiating interstitial fluid from cerebrospinal fluid. Anesthesiology. 1985;63:120.CrossRefPubMedGoogle Scholar
  8. 8.
    Liberman LM, Tourtellotte WW, Newkirk TA. Prolonged post-lumbar puncture cerebrospinal fluid leakage from lumbar subarachnoid space demonstrated by radio isotope myelography. Neurology. 1971;21:925–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • John G. Brock-Utne
    • 1
  1. 1.Department of AnesthesiaStanford UniversityStanfordUSA

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