An unexpected lumbar lesion in an elective C/S patient
A 26-year-old primigravida, pregnant with twins (breech positioning), presented for an elective cesarean section. The patient was in theatre being prepared for spinal aaesthesia when the consultant anesthetist observed a large scarred and dimpled area, surrounded by significant hair growth in the region of the lumbar spine [Figure 1] and [Figure 2]. She had attended all her antenatal appointments and was seen in a preoperative clinic the day before surgery, however, the lesion was not recognized or noted in any of these encounters.

The patient subsequently reported possibly having had an operation on this area many years previously as a child in Pakistan but was uncertain as to the exact nature of the surgery. She stated that she had never had any neurological symptoms. There was a concern that the examination findings represented spina bifida, and as such spinal anesthesia was contraindicated without a MRI. The patient was re-consented and general anesthesia was performed....

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