Ischemic colitis

[painfre]

I have a pt who developed abd pain secondary to Inferior mesentric Ischemia after a femoro popliteal bypass surgery. CT angio shows Ischemic colitis secondary to Inferior mesentric ischemia. I am thinking of doing Coeliac plexus block. Any other options. Celiac pexus block may not relieve pain of descending colon ?

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[lobelsteve]

Not sure about altering vasomotor tone to ischemic bowel. Celiac should increase blood flow- but would that cause harm? Reperfusion injury? I'd pass.

 

[hyperalgesia]

Is this is a hospice case? Ischemic bowel just doesn't seem like something you'd want to denervate.

 

[SleepIsGood]

I have a pt who developed abd pain secondary to Inferior mesentric Ischemia after a femoro popliteal bypass surgery. CT angio shows Ischemic colitis secondary to Inferior mesentric ischemia. I am thinking of doing Coeliac plexus block. Any other options. Celiac pexus block may not relieve pain of descending colon ?

Is the PMD asking for this? Would be interesting to see if it works.

 

[lobelsteve]

Anatomically, I believe once you cross the splenic flexure you are in superior hypogastric territory. But I still don't see blocking the sympathetics as something I'd be comfortable with for this diagnosis.

 

[Tenesma]

WTF??? don't touch that with a needle ... defer to vascular surgery and suggest epidural catheter for pain control while awaiting surgical plan as an inpatient.

 

[painfre]

Vascular surgery referred to pain service for control of pain. they are not planning to do any surgery.

 

[deleted185747]

Question for those who know: Would a SCS help this person? It works for angina...

 

[lobelsteve]

Question for those who know: Would a SCS help this person? It works for angina...

It only works when done at the Cleveland Clinic. At least that's what the data says.

 

[Tenesma]

how do you get IMA territory ischemia w/ a fem-pop??? are you kidding me? what kind of surgeons are you dealing with?

i bet it has nothing to do w/ fem pop and that this is just a vasculopath who happened to get IMA ischemia...

as long as there is ischemia going on, there is NO good pain control other than improving blood flow...
1) get a 2nd opinion from another vascular surgeon
2) talk to vascular IR and find out if they can stent open the IMA?
3) consider an epidural if oral pain control insufficient and patient not currently anti-coagulated.... i would not do a denervation (and celiac plexus ain't gonna cut it) in a patient with ischemic issues, cause by the time you find out the gut has infarcted, the ptient will be dead.
4) make the patient NPO, get parenteral IV nutrition started and come up with other strategies to de-stress the gut...

this sounds like a horrible situation.

 

[drf]

It only works when done at the Cleveland Clinic. At least that's what the data says.

Is there not a variety of European studies using SCS for CAD and PAD?

 

[lobelsteve]

Is there not a variety of European studies using SCS for CAD and PAD?

Angina and PAD are well supported, but abd pain is not. I believe it is more cord topography issues than anything else.

Kind of like SCS for the axial back fibers. We know they are in there, we just kind find a way to make the stimulation paresthesia comfortable, focused, and without overlap dysesthesia.

 

[painfre]

sorry, my mistake its not fem popliteal bypass it is aorto bifemoral bypass. I am not going to do any blocks in this pt. SCS may be an option if he does not get any relief since no insurance issues.