Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis

Celiac plexus neurolysis (CPN) may be an effective means of reducing pain in selected patients with chronic pancreatitis. Several studies have shown that EUS-guided injection of alcohol, local anesthetic, and steroids is effective and safe. 1 Levy M.J. Topazian M.D. Wiersema M.J. et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol. 2008; 103: 98-103 Crossref PubMed Scopus (205) Google Scholar , 2 Michaels A.J. Draganov P.V. Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis. World J Gastroenterol. 2007; 13: 3575-3580 Crossref PubMed Scopus (71) Google Scholar , 3 O'Toole T.M. Schmulewitz N. Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series. Endoscopy. 2009; 41: 593-597 Crossref PubMed Scopus (76) Google Scholar , 4 Puli S.R. Reddy J.B. Bechtold M.L. et al. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci. 2009; 54: 2330-2337 Crossref PubMed Scopus (258) Google Scholar Frequent complications include transient arterial hypotension, diarrhea, and pain. Death resulting from EUS-guided CPN has not been reported so far, to our knowledge. 5 Adler D.G. Jacobson B.C. Davila R.E. et al. ASGE guideline: complications of EUS. Gastrointest Endosc. 2005; 61: 8-12 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar , 6 Fugere F. Lewis G. Coeliac plexus block for chronic pain syndromes. Can J Anaesth. 1993; 40: 954-963 Crossref PubMed Scopus (44) Google Scholar We report a case in which a patient experienced lethal necrosis of the stomach and aorta after multiple CPN procedures.