How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall – A case reportReport as inadecuate




How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall – A case report - Download this document for free, or read online. Document in PDF available to download.

BMC Urology

, 2:9

First Online: 10 September 2002Received: 20 May 2002Accepted: 10 September 2002

Abstract

BackgroundWe present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma.

Case presentationA 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of Pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous.

Results and ConclusionPercutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of Pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2490-2-9 contains supplementary material, which is available to authorized users.

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Author: Subramanian Vaidyanathan - Bakul M Soni - Peter L Hughes - Gurpreet Singh - John WH Watt - Tun Oo - Pradipkumar Sett

Source: https://link.springer.com/







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