Korean J Anesthesiol.  2017 Feb;70(1):81-85. 10.4097/kjae.2017.70.1.81.

Treatment of radiation-induced cystitis and vulvodynia via a ganglion impar block using a lateral approach under computed tomography guidance: a case report

• Lee JE
• Kwak KH
• Hong SW
• Jung H
• Chung SY
• Park JM

• KMID: 2402900
• DOI: http://doi.org/10.4097/kjae.2017.70.1.81

Abstract

Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.

Keyword

Cystitis; Nerve block; Radiation; Radiotherapy; Sympathetic ganglia; Vulvodynia

MeSH Terms

Colorectal Neoplasms
Connective Tissue
Cystitis*
Dysuria
Female
Fibrosis
Fluoroscopy
Ganglia, Sympathetic
Ganglion Cysts*
Humans
Middle Aged
Needles
Nerve Block
Radiotherapy
Rectal Neoplasms
Recurrence
Urination
Vulvodynia*