Treatment of abdominal segmental hernia, constipation, and pain following herpes zoster with paravertebral block

Abstract

Herpes zoster (HZ) most commonly occurs in elderly patients and involves sensory neurons resulting inpain and sensory changes. Clinically significant motor deficits and visceral neuropathies are thoughtto be relatively rare. A 72-year-old man presented with abdominal segmental hernia, constipation,and pain following HZ in the left T9-10 dermatome. Sixteen days before presentation, he haddeveloped a painful herpetic rash in the left upper abdominal quadrant. Approximately 10 daysafter the onset of the rash, constipation occurred and was managed with daily oral medication withbisacodyl 5 mg. In addition, 14 days after the onset of HZ, the patient noticed a protrusion of the leftupper abdominal wall. Abdominal x-ray, ultrasound of the abdomen, and electrolyte analysis showedno abnormalities. General physical examination revealed a reducible bulge in his left upper quadrantand superficial abdominal reflexes were diminished in the affected region. Electromyographic testingrevealed denervational changes limited to the left thoracic paraspinal muscles and supraumbilicalmuscles, corresponding to the affected dermatomes. He was prescribed with 500 mg of famciclovir3 times a day for 7 days, and pregabalin 75 mg twice a day and acetaminophen 650 mg 3 times aday for 14 days. However, his pain was rated at an intensity of 5 on the numerical analogue scalefrom 0 (no pain) to 10 (worst pain imaginable). A paravertebral block was performed at T9-10with a mixture of 0.5% lidocaine 3 mL and triamcinolone 40 mg. One day after the procedure, theabdominal pain disappeared. In addition, 5 days after the intervention, the abdominal protrusion andconstipation were resolved. He currently remains symptom free at a 6 month follow-up.