| Hemorrhagic gastritis and duodenitis following celiac plexus neurolysis. | |
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MedLine Citation:
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PMID: 19935986 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Scott Pello; Alan Miller; Tony Ku; Dajie Wang |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Pain physician Volume: 12 ISSN: 2150-1149 ISO Abbreviation: Pain Physician Publication Date: 2009 Nov-Dec |
Date Detail:
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Created Date: 2009-11-25 Completed Date: 2010-02-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100954394 Medline TA: Pain Physician Country: United States |
Other Details:
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Languages: eng Pagination: 1001-3 Citation Subset: IM |
Affiliation:
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Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. scott.pello@jeffersonhospital.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Abdominal Pain
/
etiology,
therapy Autonomic Nerve Block / adverse effects* Celiac Plexus / physiopathology Duodenitis / etiology* Female Gastrointestinal Hemorrhage / etiology* Humans Middle Aged Pancreatic Neoplasms / complications |
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