Epidural catheter rupture is a condition rarely described in the literature, being considered rare. The reports on the subject present discussions about the possible causes and consequences in the anesthetic act. Discussions about complications are even rarer, of which neurological symptoms, pain, inflammation, root avulsion or infectious complications. Thus, this clinical case describes an event of epidural catheter rupture in a patient during preoperative analgesia, treated by surgery. Data were obtained through a review of the medical record, interview with the patient, photographic record of the diagnostic methods and review of the literature. Patient A. C., female, 28 years old, 55 kg, 1.64 m, GIPI, with previous history of pain in right hypochondrium, associated with nausea and vomiting, diagnosed with choledocholithiasis and taken to the surgical center for conventional cholecystectomy. During insertion of the catheter for anesthesia in the thoracic epidural space, the patient reported paresthesia in the right lower limb. When withdrawing needle-catheter assembly under resistance, there was rupture of the same. It was decided to perform imaging tests, which showed a catheter fragment in the computed axial tomography. Since the patient was symptomatic, an emergency surgical procedure was performed. Keywords: epidural anesthesia; complications; epidural catheter; break.
A síndrome de Herlyn-Werner-Wunderlich (SHWW) é uma doença congênita rara dos ductos müllerianos, em que há útero didelfo, obstrução de hemivagina obstruída por septo e agenesia renal ipsilateral. A apresentação clínica mais comum é dor pélvica progressiva, dismenorreia e massa palpável. Em alguns casos a paciente pode apresentar menstruação normal devido a obstrução de apenas uma hemivagina, fato que resulta em atraso no diagnóstico. Relato do caso: Paciente, 13 anos, sexo feminino, com queixa de dor pélvica intermitente e progressiva, há um ano, associada a irregularidade menstrual, é atendida em hospital terciário. Realizada propedêutica radiológica armada e suprimido o exame físico ginecológico inicial, paciente é erroneamente diagnosticada com torção de cisto ovariano e submetida a laparotomia exploradora. Em pós-operatório, após reavaliação da história clínica e realização de exame ginecológico, evidenciou-se uma anormalidade anatômica em região de vestíbulo vaginal, compatível com septo vaginal e hematocolpo. Realizada colpotomia com drenagem de aproximadamente 900 ml de sangue de aspecto achocolatado e marsupialização do septo vaginal. Conclusões: Denota-se a importância do exame clínico para conclusão diagnóstica precoce e para evitar procedimentos cirúrgicos desnecessários, em especial na conduta de casos raros e intrigantes como a SHWW.
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