Keywords
intra-abdominal pressure
intrathecal pump
CSF fistula
cancer pain.
Abstract
Objectives: To describe the clinical case of a cerebrospinal fluid (CSF) fistula in a patient with an intrathecal pump for refractory cancer pain, secondary to increased intra-abdominal pressure caused by prostatic synovial sarcoma. Material and methods: We present the case of a 22-year-old male with poorly differentiated stage IV prostatic synovial sarcoma, treated with an intrathecal morphine pump due to severe pelvic pain unresponsive to systemic opioids. The patient underwent clinical follow-up, imaging studies, therapeutic interventions, and multidisciplinary management. Results: Tumor progression led to significant intra-abdominal compression, resulting in lumbar wound dehiscence, exposure of the intrathecal catheter, and CSF leakage confirmed by fluid analysis. The patient developed postural headache and photophobia. Antibiotics, local wound care, and a blood patch were administered with partial improvement. Due to persistent inflammation and risk of systemic infection, a complete surgical replacement of the intrathecal system was performed. Conclusions: This case highlights a rare but clinically significant complication in patients with intrathecal devices and large pelvic tumors. Increased intra-abdominal pressure can compromise device integrity, leading to CSF fistulas. Close clinical monitoring, multidisciplinary care, and early recognition of device-related complications are essential for optimal management.References
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