Paraplegia after coeliac plexus block

Abstract

SummaryA case is described in which paraplegia followed a coeliac plexus block performed using 90% alcohol under X ray screening. The likely cause was an ischaemic injury to the cord secondary to damage to the artery ofrldamkiewicz. This rare complication seems difficult to avoid.

Ganglienblockade

“…B. kleinen Bauchdecken-oder abdominellen Hämatomen werden schwerwiegende Komplikationen lediglich in Einzelfäl-len beschrieben. Diese reichen jedoch von der Paraplegie bis hin zur Magenperforation mit Todesfolge nach mehrfachem Zugang von ventral [8,9,10].…”

Celiac Plexus, Splanchnic Nerve Block, and Neurolysis

“…This study reported four complications, including asymptomatic hypotension after neurolysis, retroperitoneal abscess after celiac plexus block, and severe self-limited post-procedural pain in two patients after celiac plexus block [ 50 ] . Reports of retroperitoneal bleed and abscess [ 51 ] , urinary retention [ 36 ] , hiccoughing [ 52 ] , bowel perforation, gastroparesis [ 53 ] , hemorrhagic gastritis [ 54 ] , loss of anal and bladder sphincter function [ 42 ] , ejaculatory failure [ 55 ] , anterior spinal artery syndrome and paraplegia [ 27,30,44 ] , aortic dissection [ 56 ] , and aortic pseudoaneurysm [ 57 ] have also been described.…”

“…The neurolytic-induced vasospasm of the artery of Adamkiewicz may occur secondary to compromised perfusion due to surrounding tissue edema or by direct contraction of the arterial muscle wall [45][46][47] . Paraplegia may also result from direct injection of neurolytic agents into the artery of Adamkiewicz or radicular artery [ 27,29,44,48 ] . Even when CPB neurolysis has been performed under direct visualization by an open anterior approach, paraplegia has been a complication likely because of the close anatomical proximity of the celiac plexus to the artery of Adamkiewicz [ 49 ] .…”

“…Hardy and Wells [ 43 ] found that during injection of the celiac plexus, the injected fl uid typically spreads as high as midthoracic and cervical levels. A proposed etiology for development of paraplegia following neurolysis is the superior spread of injected alcohol or phenol causing spasm or thrombosis of the artery of Adamkiewicz [ 30,31,44 ] . The neurolytic-induced vasospasm of the artery of Adamkiewicz may occur secondary to compromised perfusion due to surrounding tissue edema or by direct contraction of the arterial muscle wall [45][46][47] .…”

Techniques anesthésio-algologiques dans le cadre des douleurs cancéreuses abdominopelviennes

“…En effet, l'utilisation du scanner et le contrôle de la diffusion permet de limiter le risque de passage intrathécal de la solution [14,15,67] ; -péritonite : en cas de passage transcolique par voie antérieure, ou cas de diffusion de la solution lytique dans le péritoine ; -insuffisance cardiaque : rapportée par Brown cité dans [13].…”