Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Pain Physician. 2009 Nov-Dec;12(6):1001-3.
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.
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.
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.
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.
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.
神经松解腹腔神经丛阻滞术是一种已被广泛认可的缓解疼痛的干预手段，它可以改善患有上腹部恶性肿瘤（特别是胰腺癌）患者的生活质量。
我们描述了一位 61 岁女性患者的病例，她患有胰腺癌病史，近期无明显诱因出现无法解释的输血依赖型贫血，且近期上消化道内镜检查未见异常，同时伴有腹痛。该患者曾行胃空肠吻合术和 Roux-en-Y 肝肠吻合术，以及化疗和放疗。她因腹部剧烈疼痛而无法缓解，选择接受姑息性腹腔神经丛神经松解术。
患者最初似乎能很好地耐受腹腔神经丛阻滞，但在术后 45 分钟时出现直肠鲜红色血便，随后出现血便。她的腹部柔软，无压痛，轻度膨胀，肠鸣音正常。患者的血红蛋白从 9.0g/dl 降至 7.5g/dl，接受了输血治疗。上消化道内镜和肠内镜检查显示弥漫性出血性胃炎和十二指肠炎。出血得到控制，患者血流动力学稳定。最终，患者病情好转并出院回家。
我们报告了一例已知胃炎和十二指肠炎病史的患者，在腹腔神经丛神经松解术后立即出现严重上消化道出血。目前尚无类似病例的文献报道。很难对此并发症提供确切的生理学解释。然而，我们推测腹腔神经丛神经松解术抑制了腹腔神经丛的交感神经张力，导致胃肠道血流增加，从而导致先前处于静止状态的出血性胃炎和十二指肠炎出现活动出血。
对于有胃炎、十二指肠炎或胃肠道出血病史的患者，在接受腹腔神经丛神经松解术之前，进行仔细的上消化道评估可能是有益的。
