Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Neurolytic celiac plexus blocks can effectively ameliorate intractable epigastric pain caused by intraabdominal cancers. Multiple techniques have been described, including transaortic and transdiscal needle placement. The authors have preferred the single needle transaortic fluoroscopically-guided technique owing to the reproducible anatomic landmarks for needle tip placement within the anterior periaortic space at the midline of the T12-L1 spinal segment.
CASE REPORT: A 70-year old man with intractable localized epigastric pain from stage IV adenocarcinoma of the stomach was referred for consideration of a neurolytic celiac plexus block. The abdominal computed tomography scan revealed a noncalcified abdominal aorta that was centrally located at the T12-L1 level. Face validity correlates optimal anatomic needle placement and the resultant minimal neurolytic injectate volume with maximal efficacy and minimal side effects. While specific fluoroscopic images guide needle track and depth, tactile sensations and blood return provide physiological confirmation of needle tip location. A characteristic contrast pattern confirms attainment of the anatomic target. We discuss a novel technique—a single needle transdiscal, transaortic approach—for celiac plexus neurolysis in a patient with atypical abdominal aortic anatomy.
CONCLUSIONS: This case demonstrates an effective, uncomplicated celiac plexus neurolysis using a small injectate volume. The authors present this case as a novel approach to celiac plexus neurolysis combining 2 previously described techniques.
KEY WORDS: Celiac plexus, neurolysis, single needle, transaortic, transdiscal