Endoscopic ultrasound-guided celiac plexus neurolysis in pancreatic cancer-associated pain: different technical approaches in three challenging cases

Abdominal pain is severe in the vast majority of patients with pancreatic cancer. In some cases, chronic use of analgesics markedly reduces quality of life due to side effects. Endoscopic ultrasound-guided celiac plexus neurolysis is a procedure that controls cancerassociated pain in this population and consists of injecting a neurolytic agent around or within the celiac plexus. In this report, we present three cases with different technical approaches for celiac plexus neurolysis.

El cáncer de páncreas se puede presentar con dolor abdominal intenso, siendo necesario el uso de analgésicos a largo plazo en muchos de los pacientes. Sin embargo, estos medicamentos pueden tener efectos adversos que finalmente reducen la calidad de vida de los pacientes. La neurólisis del plexo celíaco guiada por ecoendoscopia es un procedimiento que controla el dolor asociado a este tipo de neoplasia y consiste en inyectar un agente neurolítico en o alrededor del plexo celíaco. Presentamos tres casos en los cuales se realizan diferentes técnicas de abordaje terapéutico.

Direct intraoperative versus percutaneous computed tomographyguided celiac plexus neurolysis in non-resectable pancreatic cancer: A randomized, controlled, non-inferiority study.

BACKGROUND: Celiac plexus neurolysis (CPN) has been used to control pancreatic cancer (PC) pain, up to our knowledge, there is no study compared intraoperative CPN and computed tomography (CT)-guided techniques. OBJECTIVES: To compare the effects of intraoperative and CT-guided CPN in unresectable PC on pain intensity and analgesic requirements. METHODS: A total of 90 patients were enrolled in this prospective, randomized, open label, controlled, non-inferiority study, 20 patients were excluded or lost to follow up. The patients were randomly allocated to either intraoperative or CT-guided CPN group. A mixture of 20 mL ethanol 90%, 100 mg lignocaine and 5 mg dexamethasone was infused on each side of the aorta in both groups. Visual analogue score (VAS) and oral daily tramadol consumption were recorded at day 7, 14, 30, 60, 120 and 180 days after intervention. Occurrence of any intervention related complications were reported. RESULTS: Median VAS was similar in both intraoperative and CT-guided CPN groups from day 7 up to 180 days after intervention. The median daily analgesic consumption of oral tramadol (mg) was comparable in both intraoperative and CT-guided CPN groups after intervention at day 7 (50 versus 50), day14 (50 versus 50), day 30 (50 versus 50), day 60 (50 versus 50), day 120 (100 versus 75) and day 180 (100 versus 100). The incidence of diarrhea, vomiting, hypotension and back pain was similar in both groups. CONCLUSION: Intraoperative CPN is non-inferior to CT-guided CPN as both techniques were similarly associated with reduced pain severity and analgesics requirements.

Neurólisis del plexo celiaco intraoperatoria directa frente a percutánea guiada por tomografía computarizada en el cáncer de páncreas no operable: estudio aleatorizado, controlado y de no inferioridad / Direct intraoperative versus percutaneous computed tomographyguided celiac plexus neurolysis in non-resectable pancreatic cancer: A randomized, controlled, non-inferiority study

Antecedentes: Se ha utilizado la neurólisis del plexo celiaco (NPC) para controlar el dolor producido por el cáncer de páncreas (CP) y, a nuestro entender, no existe ningún estudio que compare las técnicas de NPC intraoperatoria y NPC guiada por tomografía computarizada (TC). Objetivos: Comparar los efectos de NPC intraoperatoria y NPC guiada por TC en el CP no operable en cuanto a intensidad del dolor y necesidad de analgésicos. Métodos: Se incluyó a un total de 90 pacientes en este estudio prospectivo, aleatorizado, abierto, controlado y de no inferioridad, en el que se excluyó o perdió a 20 pacientes durante el seguimiento. Se asignó aleatoriamente a los pacientes en el grupo de NPC intraoperatoria o el grupo de NPC guiada por TC. En ambos grupos se inyectó una mezcla de 20ml de etanol al 90%, 100mg de lidocaína y 5mg de dexametasona en cada lado de la aorta. Se registraron la escala visual analógica (EVA) y el consumo oral diario de tramadol los días 7.°, 14.°, 30.°, 60.°, 120.° y 180.° tras la intervención. Se reportó la presencia de cualquier complicación relacionada con la intervención. Resultados: La puntuación EVA media fue similar en ambos grupos de NPC intraoperatoria y NPC guiada por TC desde el 7.° al 180.° posteriores la intervención. El consumo medio diario de analgésico (miligramos de tramadol por vía oral) fue comparable en ambos grupos tras la intervención en los días 7.°(50 frente a 50), 14.°(50 frente a 50), 3.0°(50 frente a 50), 60.°(50 frente a 50), 120.°(100 frente a 75) y 180.° (100 frente a 100). La incidencia de diarrea, vómitos, hipotensión y dolor de espalda fue similar en ambos grupos. Conclusión: La NPC intraoperatoria no es inferior a la NPC guiada por TC, ya que la asociación de ambas técnicas a la reducción de la gravedad del dolor y a las necesidades de analgésicos fue similar.(AU)

Background: Celiac plexus neurolysis (CPN) has been used to control pancreatic cancer (PC) pain, up to our knowledge, there is no study compared intraoperative CPN and computed tomography (CT)-guided techniques. Objectives: To compare the effects of intraoperative and CT-guided CPN in unresectable PC on pain intensity and analgesic requirements. Methods: A total of 90 patients were enrolled in this prospective, randomized, open label, controlled, non-inferiority study, 20 patients were excluded or lost to follow up. The patients were randomly allocated to either intraoperative or CT-guided CPN group. A mixture of 20ml ethanol 90%, 100mg lignocaine and 5mg dexamethasone was infused on each side of the aorta in both groups. Visual analogue score (VAS) and oral daily tramadol consumption were recorded at day 7, 14, 30, 60, 120 and 180 days after intervention. Occurrence of any intervention related complications were reported. Results: Median VAS was similar in both intraoperative and CT-guided CPN groups from day 7 up to 180 days after intervention. The median daily analgesic consumption of oral tramadol (mg) was comparable in both intraoperative and CT-guided CPN groups after intervention at day 7 (50 versus 50), day14 (50 versus 50), day 30 (50 versus 50), day 60 (50 versus 50), day 120 (100 versus 75) and day 180 (100 versus 100). The incidence of diarrhea, vomiting, hypotension and back pain was similar in both groups. Conclusion: Intraoperative CPN is non-inferior to CT-guided CPN as both techniques were similarly associated with reduced pain severity and analgesics requirements.(AU)

Direct intraoperative versus percutaneous computed tomographyguided celiac plexus neurolysis in non-resectable pancreatic cancer: A randomized, controlled, non-inferiority study. / Neurólisis del plexo celiaco intraoperatoria directa frente a percutánea guiada por tomografía computarizada en el cáncer de páncreas no operable: estudio aleatorizado, controlado y de no inferioridad.

BACKGROUND: Celiac plexus neurolysis (CPN) has been used to control pancreatic cancer (PC) pain, up to our knowledge, there is no study compared intraoperative CPN and computed tomography (CT)-guided techniques. OBJECTIVES: To compare the effects of intraoperative and CT-guided CPN in unresectable PC on pain intensity and analgesic requirements. METHODS: A total of 90 patients were enrolled in this prospective, randomized, open label, controlled, non-inferiority study, 20 patients were excluded or lost to follow up. The patients were randomly allocated to either intraoperative or CT-guided CPN group. A mixture of 20ml ethanol 90%, 100mg lignocaine and 5mg dexamethasone was infused on each side of the aorta in both groups. Visual analogue score (VAS) and oral daily tramadol consumption were recorded at day 7, 14, 30, 60, 120 and 180 days after intervention. Occurrence of any intervention related complications were reported. RESULTS: Median VAS was similar in both intraoperative and CT-guided CPN groups from day 7 up to 180 days after intervention. The median daily analgesic consumption of oral tramadol (mg) was comparable in both intraoperative and CT-guided CPN groups after intervention at day 7 (50 versus 50), day14 (50 versus 50), day 30 (50 versus 50), day 60 (50 versus 50), day 120 (100 versus 75) and day 180 (100 versus 100). The incidence of diarrhea, vomiting, hypotension and back pain was similar in both groups. CONCLUSION: Intraoperative CPN is non-inferior to CT-guided CPN as both techniques were similarly associated with reduced pain severity and analgesics requirements.

The macro and micro-structure of the celiac and cranial mesenteric ganglia in a long-lived rodent - paca (Cuniculus paca, Linnaeus 1766) / La macro y micro estructura de los ganglios mesentéricos celíacos y craneales en un roedor longevo - paca (Cuniculus paca, Linnaeus 1766)

SUMMARY: The celiac, cranial mesenteric and celiacomesenteric ganglia of the paca (Cuniculus paca) were found between the celiac and cranial mesenteric arteries. Two predominant patterns were found: isolated celiac and cranial mesenteric ganglion and the celiacomesenteric ganglion. At the microscopic level, the ganglia are constituted by an agglomeration of neurons surrounded by capsule of connective tissue. Most of these neurons had a single eccentric nucleus. Satellite cells and mast cells were found around the soma. The mast cells were also found ar ound blood vessels and in the capsule of the ganglia.

RESUMEN: Los ganglios celíacos, mesentérico-craneales y celíaco mesentéricos de la paca (Cuniculus paca) se encontraron entre las arterias celíaca y mesentérica craneal. Se visalizaron dos patrones predominantes: celiaca aislada y ganglio mesentérico craneal y ganglio celiaco mesentérico. A nivel microscópico, los ganglios están constituidos por una aglomeración de neuronas rodeadas por una cápsula de tejido conectivo. La mayoría de estas neuronas tenían un solo núcleo excéntrico. Se encontraron células satélites y mastocitos alrededor del soma. Los mastocitos también se encontraron alrededor de los vasos sanguíneos y en la cápsula de los ganglios.

Intervencionismo endoscópico en la pancreatitis crónica / Endoscopic Intervention in Chronic Pancreatitis

Resumen La pancreatitis crónica es un trastorno irreversible y progresivo del páncreas caracterizado por inflamación, fibrosis y cicatrización. Las funciones exocrinas y endocrinas se pierden, lo que a menudo conduce al dolor crónico. La etiología es multifactorial, aunque el alcoholismo es el factor de riesgo más importante en los adultos. Si se sospecha pancreatitis crónica, la tomografía computarizada con contraste es la mejor modalidad de diagnóstico por imágenes. Aunque los narcóticos y los antidepresivos proporcionan el mayor alivio del dolor, más de la mitad de los pacientes eventualmente requiere una intervención por endoscopia o cirugía. La colangiopancreatografía retrógrada endoscópica es una alternativa eficaz para una variedad de terapias en el tratamiento de enfermedades benignas y malignas del páncreas. En los últimos 50 años, la endoterapia ha evolucionado hasta convertirse en la terapia de primera línea en la mayoría de las enfermedades inflamatorias agudas y crónicas del páncreas. A medida que avanza este campo, es importante que los gastroenterólogos mantengan un conocimiento adecuado de la indicación del procedimiento, mantengan el volumen de procedimiento suficiente para manejar la endoterapia pancreática compleja y comprendan enfoques alternativos a las enfermedades pancreáticas, incluidos el tratamiento médico, la terapia guiada por ecografía endoscópica, el manejo de las estenosis sintomáticas y cálculos, las intervenciones sobre el plexo celíaco y el drenaje de los pseudoquistes pancreáticos.

Abstract Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis and scarring. Exocrine and endocrine functions are lost often leading to chronic pain. Its etiology is multifactorial, although alcoholism is the most important risk factor in adults. If chronic pancreatitis is suspected, computed tomography with contrast is the best imaging modality. Although narcotics and antidepressants provide the greatest pain relief, more than half of all patients eventually require intervention by endoscopy or surgery. Endoscopic retrograde cholangiopancreatography (ERCP) is an effective alternative for a variety of therapies for treating benign and malignant diseases of the pancreas. In the last 50 years, endoscopic treatment has evolved to become the first-line therapy for most acute and chronic inflammatory diseases of the pancreas. As this field progresses, it has become important for gastroenterologists to keep their knowledge of indications for this procedure up-to-date and to perform a sufficient volume of procedures to allow them to manage complex pancreatic endoscopic therapy. Keeping up-to-date should include an understanding of alternative approaches to pancreatic diseases including medical treatment, therapy guided by endoscopic ultrasound, management of symptomatic stenoses and stones, interventions on the celiac plexus, and drainage of pancreatic pseudocysts.

Rupture of celiac trunk aneurysm in patient with Behçet Disease / Ruptura de aneurisma de tronco celíaco em paciente com Doença de Behçet

ABSTRACT We report a case of a ruptured aneurysm of the celiac trunk in a 32-year-old, male patient with Behçet Disease (BD). Aneurysm resection was performed and the patient is well during a follow up of 32 months. To our knowledge, this is the first reported case of a ruptured celiac trunk aneurysm successfully treated in a patient with BD.

RESUMO Relatamos o caso de um aneurisma roto do tronco celíaco em um paciente de 32 anos, do sexo masculino, portador de Doença de Behçet (DB). A ressecção do aneurisma foi realizada e o paciente está bem, com acompanhamento de 32 meses. Até onde sabemos, este é o primeiro caso relatado de um aneurisma do tronco celíaco roto tratado com sucesso em um paciente com DB.

Intoxicação alcóolica aguda: complicação rara associada a neurólise do plexo celíaco durante procedimento cirúrgico a céu aberto em paciente com dor oncológica refratária. Relato de caso / Acute alcohol intoxication: uncommon complication associated to celiac plexus neurolysis during open surgical procedure in patient with refractory cancer pain. Case report

RESUMO JUSTIFICATIVA E OBJETIVOS: A neurólise do plexo celíaco é uma opção de tratamento da dor para pacientes com câncer abdominal refratário a outras abordagens. É acompanhada de reações adversas que são diagnosticadas e tratadas desde que o paciente receba monitorização e acompanhamento imediato após o procedimento. O objetivo deste estudo foi relatar o caso de uma paciente submetida a neurólise de plexo celíaco, evoluindo com sintomas de intoxicação alcoólica aguda diagnosticada na sala de recuperação pós-anestésica. RELATO DO CASO: Paciente do gênero feminino, 43 anos, com neoplasia de cabeça de pâncreas submetida a neurólise de plexo celíaco intraoperatório com 40mL de álcool a 98%, evolui na sala de recuperação pós-anestésica com hipotensão, hipoxemia e confusão mental, sintomas esses revertidos com hidratação por via venosa e elevação de membros inferiores. CONCLUSÃO: A alcoolização do plexo celíaco bloqueia definitivamente a dor visceral de pacientes com neoplasia de pâncreas, porém não está isenta de reações adversas, as quais podem evoluir para complicações graves caso não sejam prontamente diagnosticadas, tornando-se imprescindível o acompanhamento do paciente na sala de recuperação pós-anestésica.

ABSTRACT BACKGROUND AND OBJECTIVES: Celiac plexus neurolysis is a pain management option for patients with abdominal cancer refractory to other approaches. It is followed by adverse reactions which may be diagnosed and treated, provided patients are monitored and followed up immediately after the procedure. This study aimed at reporting the case of a patient submitted to celiac plexus neurolysis who evolved with acute alcohol intoxication diagnosed in the post-anesthetic care unit. CASE REPORT: Female patient, 43 years old, with pancreatic head cancer, submitted to intraoperative celiac plexus neurolysis with 40 mL of 98% alcohol. Patient evolved in the post-anesthetic care unit with hypotension, hypoxemia and mental confusion, which were reverted with intravenous hydration and elevation of lower limbs. CONCLUSION: Celiac plexus alcoholization permanently blocks visceral pain of pancreatic cancer patients, however it is not free of adverse reactions, which may evolve to severe complications if not promptly diagnosed, making mandatory the follow up of patients in the post-anesthetic care unit.

Bloqueo del plexo celiaco para el dolor por pancreatitis crónica û ultrasonido endoscópico versus percutánea: una revisión sistemática y meta-análisis / Endoscopic-ultrasound versus percutaneous-guided celiac plexus block for chronic pancreatitis pain. A systematic review and meta-analysis

Abdominal pain is present in the vast majority of patients with chronic pancreatitis, being frequently debilitating. Celiac plexus block (CPB) is an interventional technique that can be considered to provide a temporary pain relief. Objective: To estimate the effectiveness and safeness of endoscopic-ultrasound (EUS) comparing with percutaneous-guided CBP in patients with pancreatic pain. Methods: A systematic review of English and non-English articles using MEDLINE, EMBASE, LILACS and COCHRANE (via BVS). Study selection and data extraction: Only randomized control trials (RCT) comparing the beneficial and harmful effects of EUS and percutaneous-guided celiac plexus block for managing pancreatic pain were included. Data was extracted and analyzed on variables including pain relief and related procedure complications. Results: Two RCT met the inclusion criteria. Both studies assessed the primary outcome (reduction on pain score) and evaluated adverse effects. The drugs injected were the same; nevertheless percutaneous technique was guided by fluoroscopy in one study and by computer tomography (CT) in other. The results showed that the EUS-CPB group was more effective to reduce pain score after 4 weeks after the procedure, with risk of bias to do this affirmation. No statistical difference in pain relief at 1, 8 and 12 weeks and in complications rates. Conclusions: Based on this systematic review and meta-analysis, no statistically significant difference was noted in pain relief and complications for EUS and percutaneous - CPB...

El dolor abdominal es presente en la gran mayoría de pacientes con pancreatitis crónica, siendo con frecuencia debilitante. El bloqueo del plexo celíaco (BPC) es una técnica de intervención que puede ser considerado para proporcionar un alivio temporal del dolor. Objetivo: Estimar la eficacia y seguridad de la ecografía endoscópica-(EE) comparando con percutánea en pacientes con dolor de páncreas. Fuentes de datos: una revisión sistemática de los artículos utilizando MEDLINE, EMBASE, LILACS y COCHRANE (a través de la BVS). Selección de los estudios y la extracción de datos: se incluyeron solo ensayos controlados aleatorios que compararon los efectos beneficiosos y perjudiciales de la USE y bloqueo del plexo celiaco percutánea para el manejo del dolor de pancreas. Los datos fueron extraídos y analizados en variables incluyendo el alivio del dolor y las complicaciones de procedimientos relacionados. Resultados: Dos ensayos controlados cumplieron los criterios de inclusión. Ambos estudios evaluaron el resultado primario (reducción en la puntuación de dolor) y los efectos adversos. Las drogas inyectadas fueron las mismas; sin embargo, la técnica percutánea fue guiado por fluoroscopia en un estudio y por tomografía computarizada (TC) en el otro. Los resultados mostraron que el grupo de la EE fue más eficaz para reducir la escala de dolor después de 4 semanas del procedimiento, con el riesgo de sesgo de hacer esta afirmación. No hay diferencia estadística en el alivio del dolor en el 1, 8 y 12 semanas y en las tasas de complicaciones. Conclusiones: En base a esta revisión sistemática y meta-análisis, no se observaron diferencias estadísticamente significativas en el alivio del dolor y las complicaciones de la BCP por EE y percutánea...

Celiac plexus block: an anatomical study and simulation using computed tomography / Bloqueio do plexo celíaco: estudo anatômico e simulação em tomografia computadorizada

Objective: To analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized. Materials and Methods: One hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded. Results: Aortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed. Conclusion: Considering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject. .

Objetivo: Analisar variações anatômicas relacionadas ao bloqueio do plexo celíaco por meio da simulação por tomografia computadorizada e avaliar a possibilidade de transfixação de órgãos pelo método transcrural. Materiais e Métodos: Cento e oito imagens de tomografias computadorizadas transaxiais abdominais foram analisadas. As relações aorto-vertebral, tronco celíaco (TCe)-vertebral, TCe-aórtica e celíaco-aorto-vertebral foram registradas. Em cada imagem foram dispostas duas trajetórias de agulhas, a 9 cm e a 4,5 cm à esquerda e à direita da linha média. Os órgãos vitais transfixados e associações relacionadas ao gênero foram registrados. Resultados: Aorto-vertebral - 45,37% esquerda e 54,62% central; TCe-vertebral - T12, 36,11%; T12-L1, 32,4%; L1, 27,77%; T11-T12, 2,77%; TCe-aórtica - 53,7% esquerda e 46,3% central; celíaco-aorto-vertebral - L-l, 22,22%; M-m, 23,15%; L-m, 31,48%; M-l, 23,15%. Em nenhum dos critérios analisados houve correspondência no lado direito e nem associação significativa entre os gêneros. Conclusão: O bloqueio do plexo celíaco não deve ser padronizado, em razão das amplas variações anatômicas abdominais e das características próprias de cada acesso, sendo necessário o registro de imagem prévio ao procedimento para cada paciente, visando diminuir riscos de lesão. Registros sobre a variação anatômica quanto ao gênero, relacionados ao bloqueio do plexo celíaco, devem ser aprofundados. .

Neurólise de plexo celíaco por via anterior guiada por tomografia computadorizada: relato de caso / CT-guided anterior celiac plexus neurolysis: case report

JUSTIFICATIVA E OBJETIVOS: A dor oncológica exige outras opções terapêuticas além do tratamento farmacológico para melhor controle e, portanto, deve-se sempre que possível utilizar técnicas e modalidades intervencionistas para controle da dor, pois assim pode--se oferecer aos pacientes melhor qualidade de vida e melhora da resposta terapêutica ao tratamento instituído.O objetivo deste estudo foi apresentar uma técnica intervencionista de simples execução, adequadamente tolerada pelo paciente, com ótimo resultado antálgico e isenta de maiores intercorrências.RELATO DO CASO: Paciente do sexo feminino,50 anos com quadro neoplásico decorrente de tumor de canal anal e dor refratária ao tratamento farmacológico multimodal com analgésicos. Submetida à neurólise de plexo celíaco por via anterior, guiado com tomografia computadorizada mediante punção única e injeção de álcool a 97%, obtendo controle efetivo do quadro álgico abdominal e retorno às tarefas da vida cotidiana.CONCLUSÃO: A neurólise do plexo celíaco por via anterior com punção única sob tomografia foi efetiva para o controle do quadro doloroso abdominal em paciente com tumor anal e metástase hepática irressecável.

BACKGROUND AND OBJECTIVES: Cancer pain requires other therapeutic options in addition to pharmacological treatment for better control. So, whenever possible, one should use interventionist pain control techniques and modalities to offer better quality of life and improve therapeutic response to treatment. This study aimed at presenting a simple interventionist technique,adequately tolerated by patients, with excellent pain relief and free of major intercurrences.CASE REPORT: Female patient, 50 years old with neoplasia resulting from anal canal tumor and pain refractory to multimodal analgesic treatment. CT-guided anterior celiac plexus neurolysis by single puncture and 97% alcohol injection has provided effective abdominal pain control and return to daily activities.CONCLUSION: CT-guided celiac plexus neurolysis with single puncture was effective to control abdominal pain in a patient with anal tumor and unresectable liver metastasis.

Tratamiento quirúrgico del aneurisma del tronco celíaco, reporte de un caso / Surgical treatment of aneurysm of the celiac trunk: case report

Los aneurismas del tronco celíaco son un problema clínico infrecuente. La mayoría de los pacientes son sintomáticos al momento del diagnóstico; sin embargo, ocasionalmente se detectan de manera incidental durante estudios imagenológicos para otras enfermedades. Se presenta el caso de un paciente de 54 años con aneurisma sintomático del tronco celíaco, diagnosticado por tomografía e intervenido quirúrgicamente de manera satisfactoria.

Aneurysm of the celiac artery is an uncommon clinical problem; fewer than 180 cases have been reported in the world's medical literature. Most patients are symptomatic at the time of diagnosis. However, occasionally such aneurysms are detected incidentally during diagnostic imaging for other diseases. We present of a 54 years-old man who had a symptomatic celiac artery aneurysm detected by Computed tomography. The patient underwent successful resection of the aneurysm and revascularization of the celiac artery – common hepatic and splenic arteries with use of an PTFE graft.

Ultrasound-guided percutaneous celiac plexus neurolysis using the anterior transgastric approach and continuousflow apneic ventilation: case report / Neurólise percutânea do plexo celíaco guiada por ultrassom utilizando um acesso anterior transgástrico e oxigenação apneica de fluxo contínuo: relato de caso

A neurólise percutânea do plexo celíaco é um método eficiente para reduzir a dor em pacientes com neoplasia abdominal avançada, principalmente em casos de câncer pancreático. Foi realizada uma neurólise percutânea do plexo celíaco guiada por ultrassom, usando a via anterior transgástrica e anestesia geral com oxigenação apneica em um paciente portador de adenocarcinoma avançado de pâncreas e dor abdominal crônica refratária a tratamento medicamentoso. Produziu-se um fluxo detectável pelo ultrassom com Doppler colorido na ponta de uma agulha fina (22G), pela injeção contínua de solução salina, otimizando sua visualização durante a progressão guiada por imagem. Esta estratégia permitiu o posicionamento rápido e preciso da agulha no espaço pré-aórtico adjacente ao tronco celíaco. Cerca de 30 ml de álcool absoluto foi injetado, de forma a promover a ablação química do plexo nervoso. O procedimento durou apenas oito minutos e o paciente referiu uma melhora significativa do quadro álgico ao seu término, tendo sido possível a redução significativa da prescrição analgésica diária.

A review on the celiac trunk compression syndrome: some anatomic clinical-surgical aspects / Una revisión del síndrome de compresión del tronco celíaco: algunos aspectos anatómicos clínicos-quirúrgicos

The objective of this study was to review some celiac trunk compression syndrome aspects such as: symptom-posture relationship; absence of symptoms; syndrome-age relationship; angiographic study on anatomy of the celiac trunk stenosis; congenital or acquired origin; invasive diagnostic tests; surgical and postoperative results.

El objetivo de este estudio fue hacer una revisión del síndrome de compresión del tronco celíaco, en cuanto a aspectos tales como: relación síntoma-postura; ausencia de síntomas; relación síndrome-edad; estudio angiográfico sobre la anatomía de la estenosis del tronco celíaco; origen congénito o adquirido; tests diagnósticos no invasivos; resultados quirúrgicos y post-quirúrgicos.