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Palliative Chemical Splanchnicectomy

James Copping, MD; Robert Willix, BS; Richard Kraft, MD
Arch Surg. 1969;98(4):418-420. doi:10.1001/archsurg.1969.01340100050004.
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Surgeons can rarely offer more than palliative therapy for patients with pancreatic carcinoma. Resections for cure were possible in only 15% of Howard's cases.1 Pain and jaundice are usually present and become more severe as the disease progresses.2 Biliary and gastrointestinal bypasses are of value in the control of pruritis and vomiting, yet are unlikely to influence the intractable pain all too frequently characteristic of this lesion. A means to alleviate this discomfort, particularly if safe and easily performed at the time of celiotomy, would seem a valuable addition to the surgeons armamentarium. Chemical splanchnicectomy is indeed such a procedure.

Anatomy  The splanchnic nerves and sympathetic trunks are the sole mediators of pain arising from the pancreas, extra hepatic biliary ducts, duodenum, stomach, small intestine, and colon, excepting the rectosigmoid.3 The pancreas and associated dorsal peritoneum have visceral afferent fibers originating from the 5th through 9th thoracic levels,


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