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
Celiac Plexus Neurolysis Using Three Different Techniques for Upper Abdominal Metastatic Pain: Comparison the Effectiveness of the Block