Neural block therapy for radiation enteritis: a case report

Abstract

Background: Radiation enteritis following radiotherapy targeting the abdomen occasionally causes ulcers or ileus, which can be difficult to treat and usually progressive and refractory, significantly degrading the patient's quality of life. Case presentation: A 58-year-old woman had undergone surgery for cervical cancer approximately 21 years ago. During treatment, she had also received radiotherapy targeting the pelvis and stomach. She presented with complaints of vomiting and lower abdominal pain and was subsequently diagnosed with multiple gastric ulcers, enterocolitis, and paralytic ileus due to late radiation-induced sequelae. We reasoned that visceral sympathetic block would improve the abdominal symptoms; therefore, we performed a splanchnic nerve block and an inferior mesenteric artery plexus block. As predicted, these block procedures improved the symptoms. Conclusions: Radiation enteritis is an iatrogenic disease, and there is no established treatment for intractable cases. However, visceral sympathetic nerve block may show efficacy as a potential therapy for radiation enteritis-associated abdominal pain and ileus.

Inferior mesenteric plexus block under computed tomography guidance

“…The inferior mesenteric plexus block is known to be useful for lower abdominal pain, especially for that occurring in the left side. [4][5][6][7] As in this case, considerable anatomic deformation occurs if there are extensive growth, invasion, and metastasis of the tumor in the abdomen and the abdominal aorta and its major arterial branches are encased. This greatly hinders the safe and accurate implementation of the inferior mesenteric plexus block.…”

“…Therefore, as the patient complained of left lower abdominal pain, unlike most patients with pancreatic cancer, inferior mesenteric plexus block was performed. The inferior mesenteric plexus block is known to be useful for lower abdominal pain, especially for that occurring in the left side [4–7] . As in this case, considerable anatomic deformation occurs if there are extensive growth, invasion, and metastasis of the tumor in the abdomen and the abdominal aorta and its major arterial branches are encased.…”

“…Unilateral or bilateral lower abdominal pain is the specific indication for an inferior mesenteric plexus block or chemical neurolysis in patients with chronic diseases or cancer. [4][5][6][7] However, the safety of the procedure is compromised when the patient is unable to execute a position suitable for the procedure owing to severe abdominal pain. [8] In addition, when considerable anatomic deformation occurs owing to extensive growth, invasion, and metastasis of the tumor in the patient's abdominal cavity, the procedure may not be performed accurately and the possibility of side effects of the procedure can be increased.…”

“…It is supplied directly by the left L2 lumbar splanchnic nerve. Unilateral or bilateral lower abdominal pain is the specific indication for an inferior mesenteric plexus block or chemical neurolysis in patients with chronic diseases or cancer [4–7] . However, the safety of the procedure is compromised when the patient is unable to execute a position suitable for the procedure owing to severe abdominal pain [8] .…”