title: Retroperitoneal abscess after neurolytic celiac plexus block from the anterior approach.
abstract: OBJECTIVE
  The anterior approach for celiac plexus block has the potential risks of infection, hemorrhage, and fistula formation. We report a case of a patient who developed a retroperitoneal abscess with the formation of a vascular-enteric fistula after a neurolytic celiac plexus block from the anterior approach.
  
  
  METHODS
  A 60-year-old female with a history of pain secondary to chronic idiopathic calcifying pancreatitis (VAS 7-8) underwent a subtotal resection of the head of the pancreas with an end-to-side pancreatojejunostomy using a Roux-en-Y loop. Pain continued secondary to chronic pancreatitis. Because of intolerance (vomiting and constipation) of morphine and transdermal fentanyl over a 2-month period, it was decided to perform a neurolytic celiac plexus block using the anterior approach with ultrasound guidance. The patient's pain was completely relieved, enabling withdrawal of oral analgesics. Pain reappeared after 2 years, and the same technique was repeated. Ten days later, she was admitted with diabetic ketoacidosis and lower gastrointestinal bleeding. Computed tomography showed a left paravertebral retroperitoneal abscess; arteriography suggested a fistula between the mesenteric vein and the jejunum. Urgent surgery was undertaken, revealing a leak of the pancreatojejunostomy and a large abscess around the celiac plexus. A distal pancreatectomy and partial resection of the Roux-en-Y loop was performed. The patient was discharged 1 month later in good clinical condition. Because of recurrent pain, she has required repeated neurolytic celiac plexus blocks via a posterior approach without complications.
  
  
  CONCLUSIONS
  The posterior approach for neurolytic celiac plexus block should be considered in particular in patients with previous pancreatic surgery.
authors.affiliation: Pain Unit, Department of Anesthesiology, Hospital Universitario del Mar, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Navarro-Martinez
authors.forename: Antonio
authors.initials: A
authors.lastname: Montes
authors.forename: Olga
authors.initials: O
authors.lastname: Comps
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitges-Serra
mesh_terms: D018784:Abdominal Abscess / Q000139:chemically induced* / Q000473:pathology*; D001340:Autonomic Nerve Block / Q000009:adverse effects*; D002447:Celiac Plexus / Q000187:drug effects / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012187:Retroperitoneal Space / Q000473:pathology