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Case Reports
. 2024 May 8;16(5):e59879.
doi: 10.7759/cureus.59879. eCollection 2024 May.

Epidural Hematoma in Minor Hepatic Metastasectomy

Sofia Pereira  1 , Sara Nunes  1 , Mariana Luís  1
Affiliations
Case Reports

Epidural Hematoma in Minor Hepatic Metastasectomy

Sofia Pereira et al. Cureus. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Thoracic and lumbar CT scan
A hyperintense lesion displacing the cord anteriorly at T8-T10 (indicated by red arrow).
Figure 2
Figure 2. Thromboelastometry showing no activation of clot formation in EXTEM
EXTEM: extrinsically activated thromboelastometry
Figure 3
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
See this image and copyright information in PMC

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