Epidural Hematoma in Minor Hepatic Metastasectomy

Abstract

Liver resection poses many challenges for the anesthesiologist, including intraoperative hemodynamic instability, postoperative pain, and risk of coagulopathy. We report a case of epidural hematoma after epidural catheter removal, following a minor liver single metastasectomy. The main purpose of this case report is to bring to light the false security provided by traditional coagulation parameters and whether further investigation should be considered in selected cases, before handling neuraxial catheters. Alterations in coagulation after a partial hepatectomy remain poorly understood; thus, we believe that additional hemostatic values such as viscoelastic testing might be considered to better assess these patients.

Keywords: coagulation tests; epidural catheter complication; epidural hematoma; hemostatic disorders; liver resection.

Figure 1. Thoracic and lumbar CT scan

A hyperintense lesion displacing the cord anteriorly at T8-T10 (indicated by red arrow).

Figure 2. Thromboelastometry showing no activation of clot formation in EXTEM

EXTEM: extrinsically activated thromboelastometry

Figure 3. Flowchart of events and the subsequent management

PACU: post-anesthesia care unit; IntCU: intermediate care unit; FFP: fresh frozen plasma; PC: platelet concentrate; PCC: prothrombin complex concentrate; PTc: platelet count; PT: prothrombin test; INR: international normalized ratio