Radiofrequency Ablation and Alcohol Neurolysis of the Splanchnic Nerves for a Patient With Abdominal Pain From Pancreatic Cancer

Abstract

Abdominal pain related to gastrointestinal malignancy can be notoriously difficult to manage and can lead to significant morbidity and suffering. The blockade of the celiac plexus has traditionally been performed for alleviating abdominal pain related to malignancy. Visceral structures that are innervated by these nerves include the pancreas, liver, gallbladder, mesentery, omentum, and the gastrointestinal tract from the stomach to the transverse colon. Alternatively, this pain can be treated by disrupting visceral nociceptive signals at the splanchnic nerves. In this report, we describe our experience of treating a 50-year-old male patient suffering from severe abdominal pain related to pancreatic cancer with multiple liver metastases. The patient failed medication management and had an international normalized ratio of 1.6, which was a concern for performing a celiac plexus block given the proximity of major vascular structures. The patient instead underwent radiofrequency ablation (RFA) as well as alcohol neurolysis of the bilateral splanchnic nerves and obtained significant relief from the procedure.