Abstract
A case is presented of a patient who developed fever, leukocytosis, severe back pain, local overlying spinal tenderness, and left leg weakness on the fifth day postpartum. The patient had epidural anaesthesia for ten hours duration, before and during a forceps delivery. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) of the pelvis and lumbar spine revealed swelling of the left iliacus and piriformis muscles, but no epidural abscess. A diagnosis of isolated piriformis pyomyositis with secondary sciatic nerve irritation was made, and the patient was treated with intravenous antibiotics, non-steroidal anti-inflammatory agents, and morphine analgesia. She made a full, uneventful recovery within 50 days, and was discharged requiring no medications.
Résumé
Au cinquième jour post-partum, une patiente présente de la fièvre avec leucocytose, de la lombalgie importante avec une douleur locale et une faiblesse du membre inférieur gauche. Cette patiente avait bénéficié d’une anesthésie épidurale d’une durée de dix heures, avant et pendant son accouchement aux forceps. La tomodensitométrie et l’imagerie par résonnance magnétique du bassin et de la colonne lombaire montrent une tuméfaction des muscles iliaque et piriforme gauches sans abcès épidural. Un diagnostic de pyomyosite du piriforme avec irritation du nerf sciatique est porté et la patiente traitée aux antibiotiques intraveineux, aux anti-inflammatoires non stéroïdiens et à la morphine. La récupération est complète après 50 jours et elle obtient son congé sans autre médication.
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Kinahan, A.M., Douglas, M.J., Smedstad, K.G. et al. Piriformis pyomyositis mimicking epidural abscess in a parturient. Can J Anaesth 42, 240–245 (1995). https://doi.org/10.1007/BF03010686
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DOI: https://doi.org/10.1007/BF03010686