Pain of intraabdominal organ is transduced through splanchnic and sympathetic nerve. Mallet- Guy et al introduced the method of splanchnicectomy and lumbar sympathectomy for control of pain of pancreatitis and pancreatic cancer. It has been considered as an out-dated procedure because of the long surgical incisions and the development of celiac plexus block with long needles. However, as VATS was recently applied to many thoracic surgical fields, splanchnicotomy assisted by a thoracoscope is considered as a good method for intractable abdominal pain.
Abdominal Pain* ; Celiac Plexus ; Needles ; Pancreatic Neoplasms ; Pancreatitis ; Splanchnic Nerves ; Sympathectomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopes

Treatment of intractable abdominal pain due to inoperable intraabdominal malignancy is important, and the ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions as a treatment. The author describes the technique and results of celiac plexus neurolysis under CT-guidance with various approach routes, including anterior, posterior and transaortic routes. Twenty-eight patients, ranging in age from 36 to 82 years, have been treated with this procedure. All had inoperable or recurred intraabdominal malignancies and suffered from intractable upper abdominal pain and/or back pain. The author performed the procedure using absolute alcohol by an anterior approach (n=18), posterior approach (n=6) and transaortic approach (n=4). Pain was rated according to a visual analog scale before and after the procedure to gauge treatment success. No major complications occurred. Mild hypotension occurred in five patients (18%) and transient diarrhea in six patients (21%). Twenty-one (75%) of the 28 patients had some relief of pain and 17 of these patients (61%) had good relief of pain after the procedure. The results support that CT-guided celiac plexus block with alcohol is a safe and effective means of pain control in patients with intraabdominal malignancy.
Abdominal Pain/therapy* ; Adult ; Aged ; Aged, 80 and over ; Celiac Plexus/surgery* ; Celiac Plexus/radiography ; Female ; Human ; Male ; Middle Age ; Needles ; Nerve Block/methods* ; Pain, Intractable/therapy* ; Radiography, Interventional ; Tomography, X-Ray Computed*

OBJECTIVETo investigate the effects on erectile function of transplanted major pelvic ganglion into the corpus cavernosum of adult male rats undergoing transection of bilateral cavernous nerves.

METHODSTwenty-six male Sprague-Dawley rats (3 - 4 month-old and 300 - 400 g/each) were divided into 2 groups: experimental group (transection of bilateral cavernous nerves and transplantation of left ganglion into left crus of penis, n = 16) and control group (transection of bilateral cavernous nerves only, n = 10). Erectile function was measured by injecting APO, and intracavernous pressure was measured 1 and 3 months afterwards by electric-stimulating the right major pelvic ganglion or the left crus. Half animals in each group were sacrificed 1 and 3 months afterwards for detecting nNOS-containing nerve fibers of corpus cavernosum. Electron microscopy of the implanted area was performed to assess neuronal survival.

RESULTSBoth of the two groups have no erectile response to APO injection. Electrostimulation on the right major pelvic ganglion and left crus failed to produce erection in experimental group. The mean pressure changes in the two groups, measured by stimulating the left crus, were (9.41 +/- 3.20) and (4.16 +/- 2.58) cmH(2)O 1 month afterwards, and (13.67 +/- 4.18) and (5.09 +/- 2.74) cmH(2)O 3 months afterwards, respectively (P < 0.05). An increased number of nNOS-containing nerve fibers in left crus was detected in experimental group 1 and 3 months later, compared with control one (218.7 +/- 24.5, 18.0 +/- 3.7; 183.2 +/- 19.7, 19.0 +/- 3.8; P < 0.05). Ultrastructure examination by transmission electron microscope confirmed the survival of the implanted ganglion.

CONCLUSIONMajor pelvic ganglion can survive in the corpus cavernosum, and it has significant effects on the number of nNOS-containing nerve fibers and the alteration of intracavernous pressure.

Animals ; Autonomic Denervation ; Celiac Plexus ; surgery ; Ganglia, Autonomic ; transplantation ; Graft Survival ; Male ; Nitric Oxide Synthase ; metabolism ; Penile Erection ; physiology ; Penis ; innervation ; surgery ; Rats ; Rats, Sprague-Dawley ; Transplantation, Autologous

Traumatic neuroma is a well-known disorder that occurs after trauma or surgery involving the peripheral nerve and develops from a nonneoplastic proliferation of the proximal end of a severed, partially transected, or injured nerve. We present a case of traumatic neuroma around the celiac trunk after gastrectomy in a 56-year-old man, which was confirmed by pathology. CT demonstrated the presence of a lobulated, homogeneous, hypoattenuating mass around the celiac trunk, mimicking a nodal metastasis.
Celiac Plexus/*pathology/surgery ; Diagnosis, Differential ; Gastrectomy ; Gastric Bypass ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasms, Post-Traumatic/*diagnosis/surgery ; Neuroma/*diagnosis/surgery ; Peripheral Nervous System Neoplasms/*diagnosis/surgery ; Positron-Emission Tomography ; Tomography, X-Ray Computed