Retroperitoneal haematoma is a rare complication of neuraxial anaesthesia. We report a case of a 21-year-old male undergoing laparoscopic abdominoperineal resection under combined general anaesthesia with epidural analgesia. An incidental retroperitoneal haematoma was discovered intraoperatively during the staging laparoscopy and drained, and haemostasis was achieved immediately. The epidural was placed at T11–T12 via a paramedian approach after three attempts. The patient remained neurologically intact postoperatively, and postoperative analgesia was maintained via the same epidural catheter. This case highlights that technically difficult thoracic epidural placement can, on rare occasions, precipitate a large retroperitoneal haematoma that may be haemodynamically occult in young patients.
Gupta et al. (Fri,) studied this question.