Abstract
INTRODUCTION: Pancreatic cancer patients experience debilitating pain which makes pain management an integral part of the treatment plan. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-guided CPN) is an alternative palliative therapy for patients with pain due to pancreatic cancer. We report a patient who developed paralytic ileus as a complication of EUS-guided CPN. CASE DESCRIPTION/METHODS: A 77- year-old male patient presented with nausea, vomiting, and abdominal pain of one day duration. He denied chest pain, shortness of breath, cough, dysphagia, diarrhea, or constipation. He was diagnosed with stage IV pancreatic adenocarcinoma 3 weeks prior to presentation for which he underwent EUS-guided CPN. Otherwise, past medical and surgical histories were noncontributory. He was a former smoker who quit 31 years ago. He reported moderate alcohol use and denied illicit drug use. In the emergency department, the patient appeared in mild discomfort. Vital signs demonstrated normal blood pressure, heart rate, respiratory rate, and temperature. Abdominal exam was significant for minimal epigastric tenderness without guarding or rebound. His labs showed a normal white blood cell (WBC) count and acute kidney injury with a creatinine of 1.34 mg/dL. Patient was placed on intravenous fluids with a bowel rest regimen and admitted to the hospital for further evaluation. Computed tomography (CT) scan of the abdomen showed significant gastric distension with a component concerning for obstruction at the level of the duodenum. Gastroparesis could not be ruled out with CT imaging. EGD, upper gastrointestinal tract series with barium swallow, and push enteroscopy were unremarkable. With obstruction ruled out, patient's diet was slowly advanced over the next few days. He was given anti-emetics and laxatives as needed. His abdominal pain and nausea gradually improved, and emesis subsided. Patient experienced a return of normal bowel activity. After 1 week, he was able to tolerate a full diet and was discharged home in a stable condition. DISCUSSION: Although EUS-guided CPN is a safe procedure, the procedure resulted in unexpected ileus which has rarely been reported in the literature. Future studies with large sample sizes are recommended to capture the occurrence of the rare side effects of EUS-guided CPN.
Published Version
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