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Brief report| Volume 77, ISSUE 1, P151-152, January 2013

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Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis

Published:May 25, 2012DOI:https://doi.org/10.1016/j.gie.2012.03.005
Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis
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      Celiac plexus neurolysis (CPN) may be an effective means of reducing pain in selected patients with chronic pancreatitis. Several studies have shown that EUS-guided injection of alcohol, local anesthetic, and steroids is effective and safe.
      • Levy M.J.
      • Topazian M.D.
      • Wiersema M.J.
      • et al.
      Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block.
      Am J Gastroenterol. 2008; 103: 98-103
      , 
      • Michaels A.J.
      • Draganov P.V.
      Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis.
      World J Gastroenterol. 2007; 13: 3575-3580
      , 
      • O'Toole T.M.
      • Schmulewitz N.
      Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series.
      Endoscopy. 2009; 41: 593-597
      , 
      • Puli S.R.
      • Reddy J.B.
      • Bechtold M.L.
      • et al.
      EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review.
      Dig Dis Sci. 2009; 54: 2330-2337
      Frequent complications include transient arterial hypotension, diarrhea, and pain. Death resulting from EUS-guided CPN has not been reported so far, to our knowledge.
      • Adler D.G.
      • Jacobson B.C.
      • Davila R.E.
      • et al.
      ASGE guideline: complications of EUS.
      Gastrointest Endosc. 2005; 61: 8-12
      , 
      • Fugere F.
      • Lewis G.
      Coeliac plexus block for chronic pain syndromes.
      Can J Anaesth. 1993; 40: 954-963
      We report a case in which a patient experienced lethal necrosis of the stomach and aorta after multiple CPN procedures.

      Abbreviation:

      CPN (celiac plexus neurolysis)
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      References

        • Levy M.J.
        • Topazian M.D.
        • Wiersema M.J.
        • et al.
        Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block.
        Am J Gastroenterol. 2008; 103: 98-103
        View in Article
        • Michaels A.J.
        • Draganov P.V.
        Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis.
        World J Gastroenterol. 2007; 13: 3575-3580
        View in Article
        • O'Toole T.M.
        • Schmulewitz N.
        Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series.
        Endoscopy. 2009; 41: 593-597
        View in Article
        • Puli S.R.
        • Reddy J.B.
        • Bechtold M.L.
        • et al.
        EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review.
        Dig Dis Sci. 2009; 54: 2330-2337
        View in Article
        • Adler D.G.
        • Jacobson B.C.
        • Davila R.E.
        • et al.
        ASGE guideline: complications of EUS.
        Gastrointest Endosc. 2005; 61: 8-12
        View in Article
        • Fugere F.
        • Lewis G.
        Coeliac plexus block for chronic pain syndromes.
        Can J Anaesth. 1993; 40: 954-963
        View in Article

      Article info

      Publication history

      Published online: May 25, 2012

      Identification

      DOI: https://doi.org/10.1016/j.gie.2012.03.005

      Copyright

      © 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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