Abstract Introduction Celiac plexus block (CPB) was originally performed for surgical anesthesia in upper abdominal procedures and more recently has been used for intractable abdominal pain primarily in the setting of abdominal cancers. Celiac block can also be used as both a diagnostic and potentially therapeutic evaluation of Median Arcuate Ligament Syndrome. The overall complication rate of CPB is between 1-3%. The most common complication is hypotension from autonomic disruption and diarrhea. Pneumothorax is a theoretical complication; however, there have been only two reports in the last decade. This is likely due to the most common procedural entry site being subdiaphragmatic, anterior approach at the L1 vertebral level. Case Presentation A 31-year-old female with a seven-year history of post-prandial abdominal pain underwent CT guided celiac plexus block for medial arcuate ligament syndrome. She had a medical history of irritable bowel syndrome, gastric reflux, and orthostatic hypotension. While traveling home in a personal car two hours after the procedure, she developed right lower back pain radiating to the right shoulder and shortness of breath. She presented to a nearby urgent care and was found to be in acute respiratory distress. Vital signs taken at the urgent care revealed blood pressure 111/75, heart rate 104, respiratory rate 40, and pulse oximetry of 95%. Physical exam revealed absent lung sounds in the right lung base. Chest radiograph showed the right pneumothorax without tracheal deviation. The patient was placed on two liters of supplemental oxygen and transported by ambulance to a higher level of care. During transport she became hypotensive, more tachycardic and hypoxic. Emergent chest tube placement was performed at the nearest emergency department with improvement of oxygenation, heart rate, and blood pressure. Computed tomography of the chest revealed 40-50% right sided pneumothorax with possible lung laceration and parenchymal injury of the right lower lobe. After a two-day admission she was discharged home with complete resolution of the pneumothorax. Discussion This case study highlights the importance of post-procedural chest radiography for early detection of pneumothorax, especially if there is a direct visceral pleural injury. Although generally considered safe, celiac plexus block carries the risk of serious complications-- pneumothorax is one such rare but life-threatening potential complication. This complication is most likely if celiac plexus block is performed above the L1 vertebral level and is more likely with posterior approach. This abstract is funded by: None
Wilkins et al. (Fri,) studied this question.