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Inferior mesenteric plexus block under computed tomography guidance: A case report.
Park, Jun-Mo; Hwang, Seong-Min.
Afiliação
  • Park JM; Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University.
  • Hwang SM; Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, South Korea.
Medicine (Baltimore) ; 100(19): e25866, 2021 May 14.
Article em En | MEDLINE | ID: mdl-34106636
ABSTRACT
RATIONALE Inferior mesenteric plexus block is indicated for left-sided lower abdominal pain. However, in patients with terminal cancer, severe abdominal pain can prevent the patient from maintaining the necessary posture during the procedure, and considerable anatomic deformation owing to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity can make the procedure difficult. In these cases, performing the procedures under computed tomography (CT) guidance can ensure greater safety and accuracy. PATIENT CONCERNS A 63-year-old man was referred for severe left-sided lower abdominal pain. He was unable to lie prone owing to severe lower abdominal pain and right hip surgery performed 15 years ago. His visual analog scale score was 9 out of 10. DIAGNOSES The patient had terminal pancreatic tail cancer. Compared with abdominal CT findings obtained 50 days ago, hepatic metastasis and peritoneal seeding were still present, infiltration to the tissues around the pancreas and retrogastric area was increased, and most of the abdominal aorta was encased. In addition, metastatic lymph nodes were identified in several areas on the left including the left para-aortic area. However, the lesion causing the pain could not be identified. Therefore, an inferior mesenteric plexus block was performed according to the patient's complaint.

INTERVENTIONS:

Epidural patient-controlled analgesia was performed first. The patient's pain consequently reduced to a certain level, and the prone position became possible to some extent, so a CT-guided inferior mesenteric plexus block was performed 2 days later.

OUTCOMES:

After the CT-guided inferior mesenteric plexus block, it became possible to control the patient's pain with a fentanyl patch 75 mcg/hour only, and his visual analog scale score was reduced to 4. After 4 weeks, the patient died without complaints of severe pain as before. LESSONS CT-guided inferior mesenteric plexus block can be performed in patients with left-sided lower abdominal pain, enabling a safer and more accurate procedure especially in patients with terminal cancer who are unable to lie prone owing to severe lower abdominal pain or with considerable anatomic deformation due to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Bloqueio Nervoso Autônomo / Dor Abdominal / Plexo Celíaco / Dor do Câncer Tipo de estudo: Guideline / Prognostic_studies Limite: Humans / Male / Middle aged Idioma: En Revista: Medicine (Baltimore) Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Bloqueio Nervoso Autônomo / Dor Abdominal / Plexo Celíaco / Dor do Câncer Tipo de estudo: Guideline / Prognostic_studies Limite: Humans / Male / Middle aged Idioma: En Revista: Medicine (Baltimore) Ano de publicação: 2021 Tipo de documento: Article