Spinal Epidural Abscess following Epidural Block in a Patient Who underwent Rectal Cancer Surgery: A Case Report

Katsuki Danno, Masao Kameyama, Kohei Murata, Osamu Ishikawa, Yoshihiko Kishi^* and Shingi Imaoka

Department of Surgery and Anesthesiology^*, Osaka Medical Center for Cancer and Cardiovascular Diseases

Spinal epidural abscess is a complication of continuous epidural block, and its incidence has increased to 1.96 cases per 10, 000 hospital admissions. We report and epidural abscess occurring soon after rectal cancer surgery treated to full recovery with intravenous antibiotic therapy alone. A 70-year-old woman with rectal cancer underwent low anterior resection, with an epidural catheter inserted via the L1-L2 interspace for epidural anesthesia in the operating room. On postoperative day (POD 5), she reported back pain and the catheter insertion site showed a subcutaneous abscess. We immediately removed the epidural catheter, punctured the subcutaneous abscess, and started an intravenous antibiotic therapy. The next day, she suffered a severe headache and her temperature rose to 39.4ºC. Magnetic resonance imaging (MRI) of the spine on POD 8 with gadoliniumenhanced MR imaging showed a small, 2cm long enhanced area in the posterior epidural space at L1-2 compressing the spinal cord, which we diagnosed as an epidural abscess. Since Methicillin resistant Staphylococcus aureus (MRSA) was isolated from the skin abscess, we changed antibiotics to Vancomycin (VCM) and continued intravenous antibiotic therapy. She recovered from the abscess without neurological deficit under antibiotics alone. Staphylococcus aureus is the most common causative bacterium of spinal epidural abscess and MRSA has recently become the major species. Epidural abscess management consists of early diagnosis and therapy. Early checkup and treatment should be started for patients undergoing continuous epidural block who demonstrate high fever complicated by headache.

Key words
spinal epidural abscess, epidural catheter, rectal cancer

Reprint requests
Katsuki Danno Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular diseases 1-3-3 Nakamichi, Higasinari-ku, Osaka, 537-8511, JAPAN

Accepted
January 30, 2002

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