Diagnostic imaging and stepwise removal of an entrapped epidural catheter in an obese adolescent

Epidural catheters are commonly used to provide effective postoperative analgesia and are usually removed without difficulty. We report a case of unexpected resistance during removal of an epidural catheter in an obese adolescent patient. After several unsuccessful manoeuvres, including positional changes and saline flushing, further blind traction was avoided to reduce the risk of catheter fracture or neurological injury. Imaging was done to identify the aetiology, which revealed looping of the catheter in the paraspinal muscular plane. After multidisciplinary discussion, the clinical team adopted a carefully planned and minimally invasive approach with surgical backup. The catheter was successfully removed under local infiltration anaesthesia without complications. This case demonstrates the importance of careful evaluation when resistance is encountered and highlights how imaging techniques can assist in clarifying the underlying mechanism. Based on this experience and existing literature, we outline a pragmatic stepwise approach that may assist clinicians when managing similar situations.