Epidural abscess following repeated epidural catheter placement for delivery

The case report describes an epidural abscess with pseudomonas aeruginosa after the placement of two epidural catheters within one hour in a healthy 29-year old primipara. Spontaneous delivery occurred after an episiotomy about 4 hours later. Afterwards the epidural catheter was removed completely and again 5 hours later the women was discharged from the hospital. On postpartal day 3 the patient experienced lumbar back pain, slight weakness of both legs and some difficulties to urinate. On day 14 after delivery magnetic resonance imaging revealed an epidural abscess at the height of the 4th and 5th lumbar vertebrae. Immediately a neurosurgical debridement and drainage was performed. The patient was discharged at home on the 10th postoperative day without neurological sequelae. In this case report a hematogenic infection was considered. The traumatized tissue from the two catheter placements within one hour could easily be colonized with pseudomonas aeruginosa originating from a transient bacteriemia due to an episiotomy inspite of adaequate local desinfection measures. The case report also underlines the need for proper information of the patient about the possibilities of complications after epidural anesthesia in outside patients.