scholarly journals CT-guided Celiac Plexus Neurolysis in the Management of Severe Upper Abdominal Pain

2020 ◽  
Vol 26 (2) ◽  
pp. 34-45
Author(s):  
Aleksey A. Eroshkin ◽  
Dmytro M. Romanukha
Keyword(s):  
Abdominal Pain ◽  
Celiac Plexus ◽  
Ct Guided ◽  
Upper Abdominal

scholarly journals Hemorrhagic Gastritis and Duodenitis Following Celiac Plexus Neurolysis

2009 ◽  
Vol 6;12 (6;12) ◽  
pp. 1001-1003
Author(s):  
Scott Pello
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Upper Endoscopy ◽  
Gi Bleeding ◽  
Upper Gi ◽  
History Of ◽  
Upper Abdominal ◽  
Plexus Block

Introduction: Neurolytic celiac plexus block is a well established intervention to palliate pain, and it potentially improves quality of life in patients suffering from an upper abdominal malignancy, specifically pancreatic cancer. Methods: We describe a 61-year-old female with a history of pancreatic cancer, unexplained transfusion dependent anemia with a normal recent upper endoscopy, and abdominal pain, who had previously undergone gastrojejunostomy and a Roux-en-Y hepaticojejunostomy as well as chemotherapy and radiation therapy. She suffered from intractable abdominal pain and elected to undergo palliative celiac plexus neurolysis. Results: The patient initially appeared to tolerate celiac plexus block well, however, 45 minutes after the procedure, the patient had bright red blood per rectum followed by bloody diarrhea. Her abdomen was soft and non-tender with minimal distention and positive bowel sounds. The patient’s hemoglobin decreased to 7.5 g/dl from 9.0 g/dl, and she received a blood transfusion. Upper endoscopy and enteroscopy demonstrated diffuse hemorrhagic gastritis and duodenitis. The bleeding was controlled and the patient remained hemodynamically stable. Ultimately, the patient did well and was discharged home. Discussion: We report a case of a patient with known history of gastritis and duodenitis, who developed severe upper GI bleeding immediately following the celiac plexus neurolysis. There are no published reports documenting similar cases. It is difficult to offer a precise physiologic explanation for this complication. However, we speculate that inhibition of sympathetic tone from the celiac plexus neurolysis caused increased blood flow to the GI system, and this resulted in active bleeding from previously indolent hemorrhagic gastritis and duodenitis. Conclusion: It may be beneficial for patients with a history of gastritis, duodenitis or GI bleeding to undergo a careful upper GI evaluation prior to celiac plexus neurolysis. Key words: Case report, pancreatic cancer, celiac plexus neurolysis, anemia, hemorrhagic gastritis and doudenitis, sympathetic block

scholarly journals The Effectiveness of Alcohol Versus Phenol Based Splanchnic Nerve Neurolysis for the Treatment of Intra-Abdominal Cancer Pain

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 281-292 ◽  
Author(s):  
Dhanalakshmi Koyyalagunta
Keyword(s):  
Abdominal Pain ◽  
Cancer Pain ◽  
Visceral Pain ◽  
Splanchnic Nerve ◽  
Well Being ◽  
Pain Reduction ◽  
Celiac Plexus ◽  
Safe Procedure ◽  
Abdominal Organ ◽  
Upper Abdominal

Pancreatic and other upper abdominal organ malignancies can produce intense visceral pain syndromes that are frequently treated with splanchnic nerve neurolysis (SNN) or celiac plexus neurolysis (CPN). Although commonly performed with either alcohol or phenol, there is scant literature on the comparative effectiveness, duration of benefit, and complication profile comparing the 2 agents. This study presents a retrospective chart review of 93 patients who underwent SNN for cancer-related abdominal pain in order to describe patient characteristics, examine comparative efficacy, duration of benefit, and incidence of complications with alcohol vs. those of phenol. Consistent with previous studies, SNN reduced reported pain scores while not significantly reducing opioid consumption. No difference in pain outcomes was found comparing alcohol versus phenol based neurolytic techniques. Celiac axis tumor infiltration and pre-procedural local radiation therapy did not change the effectiveness of the procedure. Our data demonstrated that 44.57% of patients had ≥ 30% pain reduction while 43.54% did not have pain reduction. Interestingly, the procedure produced significant improvements in anxiety, depression, difficulty thinking clearly, and feeling of well-being. In addition, no difference in complications was seen between the agents either. SNN was an effective and relatively safe procedure for the treatment of pain associated with pancreatic and other upper abdominal organ malignancies in our sample of patients. Choice of neurolytic agent can appropriately be left to the clinical judgment and local availability of the treating physician. The change in ancillary symptoms has a theoretical basis that supports a biopsychosocial model of pain since changes in one target area (pain) impact other related ones (depression and anxiety). Key words: Celiac plexus, splanchnic nerves, neurolysis, nerve block, alcohol, ethanol, phenol, pain, cancer pain, abdominal pain, visceral pain, symptom assessment

scholarly journals Severe hypoglycemia after celiac plexus neurolysis: An underreported adverse event?

2021 ◽  
Vol 5 ◽  
pp. 8
Author(s):  
James K. Sanayei ◽  
Neeral R. Patel ◽  
Martin E. Simons
Keyword(s):  
Pancreatic Cancer ◽  
Adverse Event ◽  
Abdominal Pain ◽  
Alcohol Intoxication ◽  
Severe Hypoglycemia ◽  
Celiac Plexus ◽  
Common Complication ◽  
Ct Guided ◽  
Glucose Levels ◽  
Blood Glucose Levels

Celiac plexus neurolysis (CPN) is a technique used to provide palliative analgesia to patients with intractable abdominal pain. We present the case of a male patient who was treated with CT-guided percutaneous CPN to manage pain from metastatic pancreatic cancer. Immediately following the procedure, the patient experienced severe hypoglycemia, which has not previously been reported as a complication of CPN. This complication may be underdiagnosed due to its similarities in presentation to alcohol intoxication, which is considered a common complication of ethanol-based CPN. This case demonstrates the need to monitor blood glucose levels following CPN, particularly in patients exhibiting symptoms of hypoglycemia.

Alcohol block of the celiac plexus for control of upper abdominal pain caused by cancer and pancreatitis

1971 ◽  
Vol 34 (4) ◽  
pp. 575-579 ◽  
Author(s):  
Carlos Gorbitz ◽  
Milam E. Leavens
Keyword(s):  
Abdominal Pain ◽  
Visceral Pain ◽  
Celiac Plexus ◽  
Modified Technique ◽  
Content Type ◽  
Upper Abdominal ◽  
Fine Print

✓ A modified technique for alcohol block of the celiac plexus in cases of upper abdominal visceral pain is described. The hazards and complications of the procedure are discussed. The results in 11 patients are reported.

scholarly journals Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain

2017 ◽  
Vol 34 (04) ◽  
pp. 376-386 ◽  
Author(s):  
Joshua Cornman-Homonoff ◽  
Daniel Holzwanger ◽  
Kyungmouk Lee ◽  
David Madoff ◽  
David Li
Keyword(s):  
Quality Of Life ◽  
Abdominal Pain ◽  
Side Effects ◽  
Celiac Trunk ◽  
Celiac Plexus ◽  
Opiate Dependence ◽  
Celiac Plexus Block ◽  
Upper Abdominal ◽  
Plexus Block

AbstractChronic upper abdominal pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in upper abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level of the plexus, referred to as celiac plexus block or neurolysis depending on the injectate, is a minimally invasive therapeutic strategy which has been demonstrated to decrease pain, improve function, and reduce opiate dependence. Various percutaneous techniques have been reported, but, with appropriate preprocedural planning, use of image guidance (usually computed tomography), and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of approach. The main benefit of the intervention may be in reduced opiate dependence and opiate-associated side effects, which in turn improves quality of life. Celiac plexus block and neurolysis are safe and effective treatments for chronic upper abdominal pain and should be considered early in patients experiencing such symptoms.

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