게시판
| 21KS-001 |
Inferior Mesenteric Plexus Block under Computed Tomography Guidance: A Case Report
칠곡경북대학교병원 마취통증의학과
서론: Inferior mesenteric plexus block is indicated for left-sided lower abdominal pain below the umbilicus and above pelvis. However, in patients with terminal cancer, severe abdominal pain can prevent the patient from maintaining the necessary posture during the procedure, and considerable anatomic deformation due to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity can make the procedure difficult. In these cases, performing the procedures under computed tomography (CT) guidance can ensure greater safety and accuracy.
증례보고: A 63-year-old man with terminal pancreatic tail cancerwas referred for severe left-sided lower abdominal pain below the umbilicus and above pelvis. He was unable to lie prone due to severe lower abdominal pain and right hip surgery performed 15 years ago. His visual analog scale (VAS) score was 9 out of 10. Compared with abdominal CT findings obtained 50 days ago, hepatic metastasis and peritoneal seeding were still present, infiltration to the tissues around the pancreas and retrogastric area was increased, and most of the abdominal aorta was encased. In addition, metastatic lymph nodes were identified in several areas on the left including the left para-aortic area. However, the lesion causing the pain could not be identified. Therefore, an inferior mesenteric plexus block was performed according to the patient’s complaint. Epidural patient-controlled analgesia was performed first. The patient’s pain consequently reduced to a certain level, and the prone position became possible to some extent, so a CT-guided inferior mesenteric plexus block was performed 2 days later. After the CT-guided inferior mesenteric plexus block, it became possible to control the patient’s pain with a fentanyl patch 75 mcg/h only, and his VAS score was reduced to 4. After 4 weeks, the patient died without complaints of severe pain as before.
결론: CT-guided inferior mesenteric plexus block can be performed in patients with left-sided lower abdominal pain below the umbilicus and above pelvis, enabling a safer and more accurate procedure especially in patients with terminal cancer who are unable to lie prone due to severe lower abdominal pain or with considerable anatomic deformation due to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity.
증례보고: A 63-year-old man with terminal pancreatic tail cancerwas referred for severe left-sided lower abdominal pain below the umbilicus and above pelvis. He was unable to lie prone due to severe lower abdominal pain and right hip surgery performed 15 years ago. His visual analog scale (VAS) score was 9 out of 10. Compared with abdominal CT findings obtained 50 days ago, hepatic metastasis and peritoneal seeding were still present, infiltration to the tissues around the pancreas and retrogastric area was increased, and most of the abdominal aorta was encased. In addition, metastatic lymph nodes were identified in several areas on the left including the left para-aortic area. However, the lesion causing the pain could not be identified. Therefore, an inferior mesenteric plexus block was performed according to the patient’s complaint. Epidural patient-controlled analgesia was performed first. The patient’s pain consequently reduced to a certain level, and the prone position became possible to some extent, so a CT-guided inferior mesenteric plexus block was performed 2 days later. After the CT-guided inferior mesenteric plexus block, it became possible to control the patient’s pain with a fentanyl patch 75 mcg/h only, and his VAS score was reduced to 4. After 4 weeks, the patient died without complaints of severe pain as before.
결론: CT-guided inferior mesenteric plexus block can be performed in patients with left-sided lower abdominal pain below the umbilicus and above pelvis, enabling a safer and more accurate procedure especially in patients with terminal cancer who are unable to lie prone due to severe lower abdominal pain or with considerable anatomic deformation due to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity.
