Acute intermittent porphyria is a metabolic error transmitted as an autosomal dominant disorder with incomplete penetrance. Its clinical picture includes intermittent abdominal pain, nausea, vomiting, and diarrhea, with or without neurological changes. We report the case of a young woman whose pain attacks were controlled with high-dose opiates, in whom we decided to perform endosonography-guided celiac plexus neurolysis (EUS-CPN). This is the first reported attempt with this new treatment option. There was significant clinical and nutritional improvement after treatment.
References
-
1
Tefferi A, Colgan J P, Solberg L A.
Acute porphyrias: diagnosis and management.
Mayo Clin Proc.
1994;
69
991-995
-
2
Grandchamp B.
Acute intermittent porphyria.
Semin Liver Dis.
1998;
18
17-24
-
3
Blom H, Andersson C, Olofsson B O, Bjerle P. et al .
Assessment of autonomic nerve function in acute intermittent porphyria: a study based on spectral analysis of heart variability.
J Intern Med.
1996;
240
73-79
-
4
Dover S B, Moore M R, Fitzsimmons E J. et al .
Tin protoporphyrin prolongs the biochemical remission produced by heme arginate in acute hepatic porphyria.
Gastroenterology.
1993;
105
500-506
-
5
Baccino E, Lan Cheong Wah L S, Bressollette L, Mottier D.
Cimetidine in the treatment of acute intermittent porphyria (letter).
JAMA.
1989;
262
3000
-
6
Rogers P D.
Cimetidine in the treatment of acute intermittent porphyria.
Ann Pharmacother.
1997;
31
365-367
-
7
Woolf C J, Thompson S W.
The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation: implications for the treatment of post-injury pain hypersensitivity states.
Pain.
1991;
44
293-299
-
8 Dubner R. Neuronal plasticity in the spinal and medullary dorsal horns: a possible role in central pain mechanisms. In: Casey KL (ed) Pain and central nervous system disease: the central pain syndromes. New York; Raven Press 1991: 143-155
-
9
Wiersema M J, Wiersema L M.
Endosonography-guided celiac plexus neurolysis.
Gastrointest Endosc.
1996;
44
656-662
-
10
Gress F G, Schmitt C, Sherman S. et al .
A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain.
Am J Gastroenterol.
1999;
94
900-905
-
11
Eisenberg E, Carr D B, Chalmers T C.
Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis.
Anesth AnaIg.
1995;
80
290-295
-
12
Ardengh J C, Ferrari A P, Posso M BS, Posso I P.
Control of oncologic abdominal pain with endosonography-guided celiac plexus neurolysis (abstract).
Endoscopy.
2000;
32
A38
A. P. Ferrari, M.D.
Rua Pedro de Toledo 980, cj 66 · 04039-002 São Paulo-SP · Brazil
Fax: + 55-11-55753834
Email: angelo@gastro.epm.br
