Anesth Pain Med.  2019 Jan;14(1):85-90. 10.17085/apm.2019.14.1.85.

Paraplegia after celiac plexus neurolysis in a patient with pancreatic cancer: A case report and literature review

• Kim SH
• Jang KH
• Cheon BK
• Lim JA
• Woo NS
• Kim HK
• Kim JH

• KMID: 2434204
• DOI: http://doi.org/10.17085/apm.2019.14.1.85

Abstract

A 65-year-old male patient underwent C-arm fluoroscopy-guided bilateral celiac plexus neurolysis to relieve peritoneal seeding-related pain associated with pancreatic cancer. Following confirmation of spreading, and no intravascular injection of contrast media, 7.5 ml of 0.25% chirocaine was injected in each side. The pain subsided after the block, with no motor or sensory deficits. Subsequently, celiac plexus neurolysis with 99.8% alcohol was performed using a posterolateral approach under fluoroscopic guidance. The patient was instructed to maintain a prone position for 2 hours while the procedure was performed. Approximately 4 hours later, the patient experienced paralysis of both lower extremities and hypoesthesia. Emergent magnetic resonance imaging of the thoracic and lumbar spine revealed gray matter signal change in the cord and conus medullaris at the T10-L1 level, and decreased perfusion at the T11-T12 vertebral bodies, suggesting spinal cord infarction. The patient remained paraplegic until his death 24 days later.

Keyword

Celiac plexus; Infarction; Pancreatic neoplasms; Paraplegia; Spinal cord

MeSH Terms

Aged
Celiac Plexus*
Contrast Media
Gray Matter
Humans
Hypesthesia
Infarction
Lower Extremity
Magnetic Resonance Imaging
Male
Pancreatic Neoplasms*
Paralysis
Paraplegia*
Perfusion
Prone Position
Spinal Cord
Spine
Contrast Media

Figure

• 

  Fig. 1 The position of the transverse computed tomography (CT) image at the L1 level (A), needle depth (B), and the angle of needle insertion to the target point (C). We assessed the enhanced CT transverse images and selected the level without vessels connecting to the aorta for needle insertion.

• 

  Fig. 2 The fluoroscopic anteroposterior (A) and lateral (B) view show the contrast medium spreading vertically over the 1st lumbar prevertebral space.

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  Fig. 3 T2-weighted sagittal (A) and transverse (B) magnetic resonance images show increased signal intensity in the spinal cord from the 10th thoracic to 1st lumbar level, suggesting the possibility of ischemic myelopathy.

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