Differential Diagnosis for Abdominal Pain Post Celiac Plexus Block

The patient presents with abdominal pain around the epigastrium radiating to the back, 2 days after an endoscopic nerve block in the celiac plexus, and has a history of pancreatic neuroendocrine tumor. Considering these factors, the differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis
  • Post-procedure pain or complication from the celiac plexus block: This is likely due to the recent intervention, which can cause temporary inflammation, bleeding, or irritation of the surrounding tissues, leading to pain.
• Other Likely Diagnoses
  • Pancreatitis: Given the patient's history of pancreatic neuroendocrine tumor and the recent procedure, pancreatitis is a plausible cause of the abdominal pain radiating to the back.
  • Hypertensive crisis: The patient's bilateral hypertension with a systolic blood pressure of 165 could be contributing to or exacerbating the abdominal pain, possibly indicating a hypertensive emergency.
• Do Not Miss Diagnoses
  • Hemorrhage or bleeding complication from the procedure: Although less common, bleeding is a serious potential complication of any invasive procedure, including celiac plexus blocks.
  • Perforation or injury to adjacent organs during the procedure: This could lead to severe abdominal pain and is a critical diagnosis not to miss due to its potential for significant morbidity and mortality.
  • Pneumoperitoneum or retroperitoneal air: Air in the abdominal or retroperitoneal space could indicate a perforation or leakage from the procedure.
• Rare Diagnoses
  • Abscess formation: A rare but possible complication following any invasive procedure, which could present with pain, fever, and other signs of infection.
  • Neurolytic complications: Although rare, damage to the nerves during the block could lead to neurolytic complications, affecting bowel function, among other issues.
  • Tumor rupture or hemorrhage: Given the patient's history of pancreatic neuroendocrine tumor, a rare but critical consideration is the rupture or hemorrhage of the tumor itself, which would require immediate attention.