title: Persistent Diarrhea after Celiac Plexus Block in a Pancreatic Cancer Patient: Case Report and Literature Review.
abstract: BACKGROUND
  Neurolytic celiac plexus block is increasingly used to treat refractory pain associated with abdominal malignancies, especially pancreatic cancer. While self-limiting diarrhea can occur commonly in patients post procedure, a very rare risk of persistent diarrhea exists.
  
  
  OBJECTIVE
  We present a case of a 70 year old female with locally advanced pancreatic adenocarcinoma who was hospitalized for persistent severe diarrhea post celiac plexus block and discuss management options for this adverse effect.
  
  
  METHODS
  A review of the current literature within the past 20 years (PubMed and Ovid databases) was conducted to discuss alternatives of management.
  
  
  RESULTS
  Ninety-three entries were found in total including duplicates and only two were included for relevance. Management options that were discussed included anti-motility agents, alpha-adrenergic agonists, and somastatin analog (octreotide). Our patient was initially treated with loperamide, hyoscine, psyllium, and cholestyramine before responding to octreotide. The patient was discharged on long-acting octreotide after her bowel routine stabilized.
  
  
  CONCLUSIONS
  Persistent diarrhea is a very rare complication of celiac plexus block and current literature regarding proper management is based largely on anecdotal evidence. For this patient octreotide was an effective agent for the management of this complication.
authors.affiliation: 1 Princess Margaret Cancer Centre, University Health Network , Toronto, Canada .|2 Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, Canada .
authors.forename: Anjie
authors.initials: A
authors.lastname: Yang
authors.affiliation: 1 Princess Margaret Cancer Centre, University Health Network , Toronto, Canada .|3 Lawrence Bloomberg Faculty of Nursing, University of Toronto , Toronto, Canada .
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Brown
authors.affiliation: 1 Princess Margaret Cancer Centre, University Health Network , Toronto, Canada .|4 Department of Family and Community Medicine, Faculty of Medicine, University of Toronto , Toronto, Canada .
authors.forename: Ernie
authors.initials: E
authors.lastname: Mak
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000503:physiopathology; D000368:Aged; D000930:Antidiarrheals / Q000627:therapeutic use*; D001340:Autonomic Nerve Block; D002447:Celiac Plexus / Q000601:surgery; D003967:Diarrhea / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use*; D010148:Intractable Pain / Q000209:etiology* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000930:Antidiarrheals; D015282:Octreotide