Combined Ultrasound-guided Celiac Plexus Neurolysis and Fluoroscopic Thoracic Splanchnic Radiofrequency Ablation for Refractory Pain in Exocrine Pancreatic Insufficiency: A Successful Multimodal Interventional Approach

Abstract Chronic abdominal pain associated with exocrine pancreatic insufficiency (EPI) is often difficult to treat. Image-guided sympathetic interventions—particularly celiac plexus neurolysis (CPN) and thoracic splanchnic nerve radiofrequency ablation (RFA)—have shown benefits in pancreatic and upper abdominal visceral pain. A 42-year-old man with EPI, type 1 diabetes mellitus, and Von Willebrand disease presented with 3 years of severe upper abdominal pain radiating to the back. Conservative therapy, including enzyme replacement and analgesics, was ineffective. He underwent ultrasound-guided CPN followed by fluoroscopic thoracic splanchnic RFA. Although the patient had a history of Von Willebrand disease, his coagulation profile (prothrombin time/international normalized ratio, activated partial thromboplastin time, and platelet count) was normal at the time of the procedure following hematology optimization. Immediate pain relief exceeded 50%. At 2 weeks, the patient had sustained 50% improvement, significantly improved sleep, and complete cessation of all analgesics. No complications occurred. Combined sympathetic intervention CPN and splanchnic RFA offered effective and durable pain control in a case unresponsive to conventional therapy.