LUMBOSACRAL PLEXOPATHY FROM ILIOPSOAS HEMATOMA AFTER COMBINED GENERAL-EPIDURAL ANESTHESIA FOR ABDOMINAL ANEURYSMECTOMY

Purpose: To report a case of iliopsoas haematoma after resection of an abdominal aortic aneurysm which resulted in a lumbosacral plexopathy Clinical features: An 81-yr-old man presented with an abdominal aortic aneurysm for aneurysmectomy and tube grafting, An epidural catheter w as placed at the L1-2 spinal level and combined epidural-general anaes thesia was provided for surgery. The surgery was complex and a suprare nal damp was necessary to obtain proximal control. A continuous infusi on of demerol through the epidural catheter was prescribed for postope rative analgesia. On the first postoperative day, examination revealed a paretic, pulseless right leg and he was returned to the operating r oom for femoral-femoral bypass. By the following day, the motor and se nsory impairment had progressed to complete paralysis with loss of ail deep tendon reflexes and absent sensation below L-1, despite palpable pulses in the leg. A CT of the abdomen demonstrated a right iliopsoas haematoma. There was no evidence of either disc herniation or an epid ural haematoma. A diagnosis of lumbosacral plexopathy secondary to a i liopsoas haematoma was made. Conclusion: Iliopsoas haematoma is a rare cause of postoperative neurological deficit following aortic vascular surgery, The haematoma results in compression of the lumbosacral neur al elements and typically presents as a femoral neuropathy. The diagno sis is clinical and can be readily validated with computed tomography.