2024 FSA Podium and Poster Abstracts
P010: MIGRATION OF GLUTEAL AUGMENTATION INJECTATE: AN UNEXPECTED RISK FACTOR FOR NEURAXIAL ANESTHESIA
Justin Scuorzo, DO1; Kevin Lukose, MD1; Marisol Perales, MD2; 1Department of Anesthesiology, Memorial Healthcare System; 2Department of Anesthesiology, Envision Physician Services
Introduction: Cosmetic injection procedures involving silicone and other polymers have become increasingly popular in South Florida despite well-documented risks (1). Patients often fail to disclose their history of cosmetic injections, potentially increasing risk for neuraxial or regional anesthetic procedures in affected areas. Here we review the perioperative management of a parturient with a reported history of spina bifida and cephalad migration of injectate from prior gluteal augmentation.
Case Report: A 42-year-old G3P0 at 34 weeks estimated gestational age presented for consultation for cesarean section due to twin gestation. The patient reported a history of spina bifida with suspicion for potential meningocele in her gluteal cleft that was diagnosed at birth. She did not have any prior surgery. An MRI of the lumbar spine showed no clear evidence of a meningocele but did reveal a nonspecific 9 x 4.8 x 5.1 cm hyperintense collection along with innumerable foci within the gluteal subcutaneous fat and gluteus maximus (Figure 1). When these results were reviewed with the patient, she disclosed that she had received a gluteal augmentation procedure with an “oil” injection in Venezuela 7 years prior. Subsequent discussion with Radiology determined that the injectate had migrated cephalad towards the lumbar region. A multidisciplinary telephone discussion with anesthesia, obstetrics, and plastic surgery determined that general anesthesia (as opposed to neuraxial anesthesia) would carry lower overall risk. The patient underwent general anesthesia with a bilateral transversus abdominis plane block for primary cesarean section without complication.
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Discussion: This case report highlights the potential risks associated with neuraxial anesthesia in the setting of gluteal augmentation. Polymers from gluteal augmentation have been found to migrate as far as the retroperitoneal space, thighs, perineum, and genital area (2,3). Such migration poses significant challenges for years or even decades: intraoperative findings have shown inflammatory tissue, fibrosis, and encapsulated silicone clusters containing fluid contents (4).
In parturients with a history of gluteal augmentation, physical examination or ultrasound may fail to thoroughly assess the extent of migration and identify potential complications, particularly in the context of neuraxial anesthesia (1). Magnetic resonance imaging (MRI) is the preferred diagnostic modality for detecting and characterizing migrated substances, even in small particles. Here MRI revealed multiple enhancing collections that increased the morbidity of neuraxial needle placement, motivating delivery under general anesthesia. This case report highlights the indispensable role of thorough history, imaging, and multidisciplinary consultation in enhancing informed consent, clinical decision-making, and patient safety.
References:
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