Chronic Diarrhea-Induced by Celiac Plexus Block?

Gafanovich, Inna; Shir, Yoram; Tsvang, Eduard; Ben-Chétrit, Eldad

doi:10.1097/00004836-199806000-00018

Cited by 19 publications

(12 citation statements)

References 12 publications

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“…Transient diarrhea is a common complication of celiac plexus neurolysis, occurring in as many as 44% of patients (4). The mechanism for diarrhea resulting from celiac plexus neurolysis is not completely understood; however, it may be caused by decreased intestinal transit time and increased peristaltic activity resulting from unopposed parasympathetic activity, a result of blocked intestinal sympathetic efferent fibers (17,55,56). Diarrhea resulting from celiac plexus neurolysis is usually self-limiting in nature (55,56).…”

Section: Complicationsmentioning

confidence: 99%

“…The mechanism for diarrhea resulting from celiac plexus neurolysis is not completely understood; however, it may be caused by decreased intestinal transit time and increased peristaltic activity resulting from unopposed parasympathetic activity, a result of blocked intestinal sympathetic efferent fibers (17,55,56). Diarrhea resulting from celiac plexus neurolysis is usually self-limiting in nature (55,56). Chronic diarrhea is rare and often refractory to treatment; its cause seems to be continued nerve injury by neurolytic agents (55,56).…”

Section: Complicationsmentioning

confidence: 99%

“…Chronic diarrhea is rare and often refractory to treatment; its cause seems to be continued nerve injury by neurolytic agents (55,56). A few studies have reported that atropine and octreotide, a somatostatin analog, may be useful in managing chronic diarrhea resulting from celiac plexus neurolysis (17,55,56).…”

Section: Complicationsmentioning

confidence: 99%

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CT-guided Celiac Plexus Neurolysis: A Review of Anatomy, Indications, Technique, and Tips for Successful Treatment

Kambadakone¹,

Thabet²,

Gervais³

et al. 2011

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The celiac plexus is the largest visceral plexus and is located deep in the retroperitoneum, over the anterolateral surface of the aorta and around the origin of the celiac trunk. It serves as a relay center for nociceptive impulses that originate from the upper abdominal viscera, from the stomach to the proximal transverse colon. Celiac plexus neurolysis, with agents such as ethanol, is an effective means of diminishing pain that arises from these structures. Percutaneous imaging-guided celiac plexus neurolysis has been established as an invaluable therapeutic option in the management of intractable abdominal pain in patients with upper abdominal malignancy. The use of multidetector computed tomography (CT) for imaging guidance has superseded other modalities and allows direct visualization of the spread of the neurolytic agent in the antecrural space. Accurate depiction of the retroperitoneal anatomy and the position of the needle tip helps avoid crucial anatomic structures such as the pancreas, aorta, celiac artery, and superior mesenteric artery. Proper patient education, meticulous preprocedure planning, use of optimal multidetector CT techniques, adjunctive CT maneuvers, and postprocedure care are integral to successful celiac plexus neurolysis. Celiac plexus neurolysis does not completely abolish pain; rather, it diminishes pain, helping to reduce opioid requirements and their related side effects and improving survival in patients with upper abdominal malignancy.

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

CT-guided Celiac Plexus Neurolysis: A Review of Anatomy, Indications, Technique, and Tips for Successful Treatment

Kambadakone¹,

Thabet²,

Gervais³

et al. 2011

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266

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“…Self-limited diarrhea lasting 36 to 48 hours has been reported in up to 60% of patients, however. It is occasionally severe and persistent [23,24], and if unrecognized may even be life-threatening [25].…”

Section: Diarrheamentioning

confidence: 99%

The development of a technique for radiofrequency lesioning of splanchnic nerves

Raj

Thomas

Heavner

et al. 1999

Current Review of Pain

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This article describes the development of a technique for radiofrequency lesioning of the splanchnic nerves. It features point neurolysis and improvement in safety from previously described techniques with the use of a curved, blunt needle. After extensive anatomic studies, the site of entry has been identified 4 cm lateral to the spinous process at the costovertebral angle of either the T11 or T12 vertebral body, and the placement of the needle tip at the junction of posterior two thirds to the anterior one third of the vertebral body. The use of a sharp, straight needle has been discouraged to prevent pneumothorax, and bowel, kidney, or nerve root injury. The radiofrequency lesion permits a point neurolysis, thus decreasing the rate of complications. Our experience of 22 patients treated with this technique has been complication-free, and the outcome was effective for all 10 patients with cancer. In the nonmalignancy group, some patients needed a second neurolysis (radiofrequency) procedure 4 months apart. There were also no secondary complications in these patients. We expect multicenter data accumulation in the coming years, which will determine the true efficacy of the radiofrequency of splanchnic nerves.

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“…A large series of 189 EUS-CPB and 31 EUS-CPN procedures which were performed in 128 and 30 patients, respectively, reported four complications (asymptomatic hypotension, retroperitoneal abscess, and severe self-limited pain in two patients). [33] Uncommon complications of celiac plexus include chronic diarrhea, [34] gastroparesis, [35] retroperitoneal hemorrhage, peripancreatic abscess formation, [36] and stomach rupture [37] (after repeated injections).…”

Section: Complicationsmentioning

confidence: 99%

Untitled

2013

Journal of Digestive Endoscopy

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Refractory chronic abdominal pain as a result of inoperable pancreatic cancer or chronic pancreatitis poses a formidable challenge and can be effectively relieved with celiac axis block or celiac plexus neurolysis (CPN). Percutaneous celiac plexus block (CPB) or computed tomography (CT)-guidance using anterior or posterior approaches has some limitations. However, endoultrasound (EUS)-guided CPB has evolved itself as an effective and safe procedure for management of refractory abdominal pain. The EUS offers advantages, which include accurate anatomic imaging, real-time monitoring of injection, and anterior approach, which avoids neurologic complications. The CPN can be combined with staging and fine-needle aspiration cytology (FNAC) of a malignancy in the same session. The present review discusses anatomic details of celiac axis block, procedure-related details, complications, contraindications, comparison to other modalities, and results of various studies and author's experience of EUS guided CPB/neurolysis.

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Chronic Diarrhea-Induced by Celiac Plexus Block?

Cited by 19 publications

References 12 publications

CT-guided Celiac Plexus Neurolysis: A Review of Anatomy, Indications, Technique, and Tips for Successful Treatment

CT-guided Celiac Plexus Neurolysis: A Review of Anatomy, Indications, Technique, and Tips for Successful Treatment

The development of a technique for radiofrequency lesioning of splanchnic nerves

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