Retroperitoneal Necrosis as a Rare Complication After Celiac Plexus Block

Ya Zhou,Reginald Alouidor,Jorind Beqari,Brendan O'Donovan

doi:10.7759/cureus.13169

Abstract

Long after surgical treatment, chronic pain continues to afflict many patients with pancreatic cancer. Multimodal pain management is the current approach to managing these complex patients. In patients with refractory pain, a celiac plexus block is a commonly used adjunct to optimize pain control. The sclerosing agents used in a celiac plexus block are known to cause local tissue necrosis as a rare complication. We present a case of extensive retroperitoneal necrosis following celiac plexus neurolysis. To our knowledge, this is the first report of extensive retroperitoneal necrosis after a celiac plexus block requiring operative management.

Highlights

A celiac plexus block is indicated for the treatment of intractable abdominal pain in the setting of malignant and benign neoplasms involving the pancreas, the biliary tree, the retroperitoneum, and other abdominal organs
The sclerosing agents used in a celiac plexus block are known to cause local tissue necrosis as a rare complication
We present a case of extensive retroperitoneal necrosis following celiac plexus neurolysis

Summary

Introduction

A celiac plexus block is indicated for the treatment of intractable abdominal pain in the setting of malignant and benign neoplasms involving the pancreas, the biliary tree, the retroperitoneum, and other abdominal organs. Complications from celiac plexus block are rare with the most common being diarrhea and orthostatic hypotension This is reported in 34% and 44% of patients respectively [1]. Minimal residual necrotic tissue of the retroperitoneum remained, and a drain was placed near the duodenum prior to formal abdominal closure His postoperative course was complicated by prolonged ileus and a low-volume pancreatic leak well controlled with the operative drain. He had persistent leukocytosis postoperatively, which was most likely from the residual necrotic tissue, and resolved by discharge. The patient was eventually started on a diet with continued low output from the pancreatic leak He was discharged home on hospital day 24 and instructed to follow up with his medical oncologist for chronic pain management

Discussion

Conclusions

Disclosures

Findings

Waldman SD