[Occlusion of an implanted peridural catheter by a plug of epidermis]

A patient suffering from intensive perianal pain due to recurrent rectal cancer, not controllable by systemic analgesics, was treated by continuous epidural morphine for a period of 8 months. Satisfactory pain relief was achieved although sometimes problems arose with the permeability of the epidural catheter. As a reason for increased resistance, the literature mentions nonspecific foreign-body reactions next to the catheter. In our patient, tumour infiltration into both the lumbosacral plexus and the epidural space leading to compression of the catheter could not positively be excluded. At autopsy an unexpected obstruction of the catheter by epidermis was observed. It could be demonstrated that pieces of epidermis may enter the catheter, bypassing the bacterial filter of the port, and can then clog the tip of the catheter.