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Hématome péridural chez une parturiente au décours d’un choc hémorragique

[Epidural hematoma after hemorrhagic shock in a parturient]

Luc Nguyen, MD^*, Béatrice Riu, MD^*, Vincent Minville, MD^*, Clément Chassery, MD^*, Isabelle Catalaa, MD and Kamran Samii, MD PhD^*

^* Du Département d’Anesthésie-Réanimation,et du
Service de Neuroradiologie, Université Paul-Sabatier, Hôpital Rangueil, Toulouse, France.

Adresser la correspondance à: Dr Luc Nguyen, Service d’Orthopédie-Traumatologie, Département d’Anesthésie, CHU Rangueil, Toulouse, France. Télécopieur : 33 (0)5 61 32 22 32 ; Courriel : cush31{at}yahoo.fr

Purpose: Epidural hematoma is a rare but serious complication of epidural anesthesia. We report a case of epidural hematoma, occurring in an obstetric patient after the epidural catheter had been withdrawn accidentally after an episode of hemorrhagic shock leading to a hypocoagulable state.

Clinical features: A patient had the epidural catheter inserted during labour when coagulation was normal. She had a postpartum hemorrhage with alteration of coagulation (platelets 16 x 10^–9·L^–1, thrombin time: 85 sec. Vital signs returned to normal after a general anesthetic, transfusion of blood products, volume repletion and ligation of hypogastric arteries. It was then noticed that the epidural catheter had been withdrawn inadvertently while the patient was hypocoagulable. The patient then developed neurological signs consistent with spinal cord compression due to an epidural hematoma. A hematoma extending from T3 to L5 was diagnosed by magnetic resonance imaging. Because the cord had minimal compression, no specific action was undertaken, other than clinical and radiological follow-up. There were no long-term sequelae.

Conclusion: In the presence of an epidural hematoma, surgery for emergency cord decompression is usually required. Another option that receives increasing attention is to monitor neurological function, but the indications for this expectant treatment are not well defined.