• The Korean Journal of Pain
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• v.19 no.1
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• pp.111-114
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• 2006

Pancreatic cancer often elicits intractable abdominal pain which has significant negative impact on the quality of life in patients. Various therapeutic modalities including celiac plexus block are being used to alleviate the pain. The anatomic location of the pancreas often hinders the spread of anesthetic or neurolytic solutions by obliterating the retrocrural space, thus making the classic retrocrural approach unsuccessful. The following case describes a patient with intractable abdominal pain originating from advanced pancreatic cancer, which could be managed successfully with thoracoscopic splanchnicectomy after retrocrural celiac plexus block had failed.

• Investigative Magnetic Resonance Imaging
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• v.23 no.3
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• pp.276-278
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• 2019

The cisterna chyli, a dilated lymphatic sac in the retrocrural space, is usually located to the right of the aorta. We report a case of a left-sided cisterna chyli, which was incidentally detected on the radiologic examinations of a preoperative workup for cholangiocarcinoma. Computed tomography (CT) and magnetic resonance (MR) images revealed a cisterna chyli measuring 2.5 cm in length in the left retrocrural space. The dilated lumbar lymphatics joined with the cisterna chyli, which was continuous with the left-sided thoracic duct. To the best of our knowledge, this is the second antemortem case of a left-sided cisterna chyli in literature. The cisterna chyli can mimic retrocrural lymphadenopathy, solid tumor with cystic degeneration, abscess or hematoma. The left-sided cisterna chyli should be referred to as a structure so as to be cautious in surgical approach.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.17-22
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• 1992

Splanchnic nerve block(SNP) is performed to relieve intractable upper abdominal cancer pain. Boas, in a technique using fluoroscopy, was the first to note the difference between transcrural celiac plexus block and retrocrural splanchnic nerve block(SNB). We have experienced 10 cases of SNB at the T12 level under control of fluoroscopy. Our results support this approach as an effective method for upper abdominal cancer pain control.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.109-115
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• 2015

Background: This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB). Methods: CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a $10^{\circ}$ bent tip needle under a $20^{\circ}$ oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured. Results: The imaginary safe oblique angle range was $26.4-34.2^{\circ}$ and $27.7-36.0^{\circ}$ on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient. Conclusions: We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a $20^{\circ}$ oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.36-41
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• 1989

Splanchnic nerve block is performed to relieve intractable upper abdominal pain caused by carcinoma of the pancreas, stomach, liver, or colon; and upper abdominal metastasis of tumors having more distant origins. We have performed splanchnic nerve blocks under control of X-ray fluoroscopy, for all cases of alcohol splanchnic nerve block at $L_1$ vertebra, to determine both the position of the needle tips and the spread of contrast media. During the period from December 1987 to August 1988, this method was used in 40 cases of malignancy at Severance Hospital and we clinically evaluated the location of the needle tip and the spread of contrast media. The results were as follows: 1) Our method was a retrocrural approach, the splanchnic nerve block, in all cases. 2) Most of the inserted needle points were located in the upper and anterolateral part of the $L_1$ vertebra on the antero posterior roentagenogram and in the upper quarter anteriorly on the lateral roentgenogram. 3) There was no specific relationship between the location of the needle and the spread of the contrast media. 4) The contrast media was spread around the needle and then upward along the anterior margin of the vertebral body in most of the cases. 5) Pain relief was obtained immediately in 37 cases (92.5%), but in 3 cases only after a second splanchnic nerve block.