Stellate ganglion block alleviates pseudo-obstruction symptoms followed by episodes of hypermetropia: case report.

BACKGROUND AND

OBJECTIVES

The chronic intestinal pseudo-obstruction due to visceral myopathy is a disorder resembling bowel obstruction but without mechanical occlusion. Frequently, parenteral nutrition becomes the final palliative treatment. A patient affected with this syndrome for 16 years was suffering causalgic pain provoked by intraveneous perfusion. Stellate ganglion block was requested in the hope of maintaining the perfusion.

METHODS

Stellate ganglion block not only stopped the pain but unexpectedly, it temporarily relieved the pseudo-obstruction symptoms. Two radiofrequency coagulations in the stellate ganglion prolonged the beneficial effects on gastrointestinal transit for more than 3 weeks, after which the symptoms returned. Multidisciplinary and multicenter advice was that further destructive treatments not be attempted.

RESULTS

Repetitive stellate ganglion blocks with 2 mL of bupivacaine 0.75% restored gastrointestinal function for more than 3 weeks. However, after performance of radiofrequency coagulation, infiltration with bupivacaine was followed by hypermetropia on the right eye of 2 weeks duration.

CONCLUSIONS

The relationship between stellate ganglion block and gastrointestinal function has not been described. This case report does not provide sufficient information to recommend this technique for pseudo-obstruction symptoms. Moreover, the result in this case is a fortuitous observation, lacking a clear scientific explanation. Further study may be warranted.