Sheared epidural catheter during an elective procedure.

Abstract

Epidural catheter fracture and retention is uncommon. Imaging techniques identifying catheter location are limited, and clear management guidelines are lacking. Radiculopathy and lumbar stenosis are recognized complications. During epidural placement in an elderly woman undergoing gynecologic surgery, a portion of the catheter was shorn off in the epidural space. Imaging, including plain X-ray and computed tomography scan had limited ability to identify the catheter. The initial neurosurgical consultation recommended leaving the catheter in place. However, the patient became symptomatic with radicular pain; 16.5 cm of the catheter were subsequently surgically removed. Retained epidural catheter fragments can be associated with long-term sequelae. Immediate removal is facilitated by a blood-clot tract and may present the best time for removal. Current imaging techniques have limited use in these situations.