Fractured epidural catheter with retained fragment in the epidural space—a case study and proposed management algorithm

A broken epidural catheter with a retained fragment in the spinal canal is a rare complication of an otherwise low-risk procedure. We present a case of a 37-year-old post-partum female with a fractured epidural catheter with a retained fragment in the epidural space, after epidural anaesthesia using a midline L3/L4 approach. The patient was completely asymptomatic, and the management decision lay between surgical exploration with removal and conservative management with no intervention. CT scan findings were unhelpful, and MRI imaging showed a probable retained fragment penetrating the midline ligamentum flavum, with the catheter tip lying within the spinal canal. The fragment was removed under general anaesthesia 3 days post-delivery. In our proposed treatment algorithm, if the residual catheter fragment is proved radiologically to lie outside the spinal canal and there is no residual catheter breaching the skin to provide a portal for infection, conservative management is reasonable. Early removal is advised when the retained fragment is within the spinal canal—preferably within days to prevent the formation of dural adhesions. This is easier under direct vision, allowing rapid discharge and avoiding much more difficult and higher risk surgery later on.