Splanchnic nerve neurolysis for chronic pain in lupus peritonitis

Systemic Lupus Erythematosus (SLE) is a multiorgan inflammatory autoimmune disease. Serositis is a common morbidity in SLE as 16% of patients suffer pleuritis and pericarditis as peritoneal serositis is a rare finding. A 32 yo female patient followed for SLE admitted to the Emergency Department with severe abdominal pain, nausea and vomiting. Her abdominal CT revealed peritoneal thickening and edema and in her abdominal CT angiogram, there was a minor narrowing of the superior mesenteric artery and a minor occlusion in the inferior mesenteric artery. The departments of Internal Medicine, Rheumatology, Gastroenterology, General Surgery and Cardiovascular Surgery evaluated the patient. No interventions were planned and pulse steroid and endoxan treatment was initiated with the diagnosis of SLE peritonitis and possible intestinal involvement. The patient was consulted to the Pain Clinic because of the interactable abdominal pain. The patient complained about the upper abdominal pain radiating to the back with a numeric rating scale of 8-9. The pain did not respond to oral tramadol 50mg bid and transdermal fentanyl 25 microgram q72hr. Then the patient was scheduled for a local anesthetic block of the splanchnic nerves. Bilateral diagnostic splachnic nerve blockade was performed in the OR conditions and the pain relieved for 1 day. After an unsuccessful attempt for a splanchnic radio frequency lesioning, a neurolytic block with 96% ethyl alcohol was performed without any complications. The patient was transferred to the Internal Medicine ward with a numeric rating scale of 0. As a conclusion neurolytic splanchnic nerve blocks may be used for interactable abdominal pain in patients with SLE peritonitis.