Epidural abscess after epidural catheter for pain release during pancreatitis

• Published in: Acta anaesthesiologica Scandinavica Vol. 44; no. 8; pp. 1024 - 1027
• Main Authors: Heller, A. R., Ragaller, M., Koch, T.
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard International Publishers 01.09.2000; Blackwell
• Subjects: Abscess - etiology; Analgesia, Epidural - adverse effects; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; diabetes; Diabetes Complications; epidural abscess; Epidural catheter; epidural hematoma; Hematoma, Epidural, Cranial - pathology; Humans; immune deficiency; Local anesthesia. Pain (treatment); Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; natural killer cells; Pain - etiology; Pain Management; pancreatitis; Pancreatitis - complications; Spinal Diseases - etiology; Tomography, X-Ray Computed; Endocrinopathy; Human; Diabetes mellitus; Abscess; Pancreatitis; Extradural space; Case study; Extradural; Infection; Analgesia; Immunosuppression; Pain; Extradural administration; Hematoma; Digestive diseases; Complication; Pancreatic disease
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2000.440823.x

Background: Despite knowledge about compromised host defence in the course of diabetes mellitus and pancreatitis, epidural analgesia (EA) is recommended for pain management during pancreatitis. Case report: We present the case of a diabetic patient with pancreatitis who developed an epidural abscess after 3 days with an epidural catheter. Natural killer and T‐helper cell counts were distinctively reduced in the absence of HIV serology. Furthermore, a synthesis failure of the liver was observed and evidenced by low cholinesterase, low whole protein fraction and low antithrombin III in the peripheral blood. Conclusion: We suggest that the combination of pancreatitis, diabetes and compromised immunity might be a contraindication to epidural analgesia.