Editor-in-Chief: Kenneth D. Candido, MD

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  1. IPM;2017;1;71-77 A Challenging Case of Ganglion Impar Block in a Patient with Coccygeal Deformity and Rectal Resection from Metastatic Rectal Cancer
    Case Report
    Kevin Wong, DO, and Brian R Monroe, MD.

The ganglion impar is a solitary retroperitoneal structure that marks the termination of paravertebral sympathetic chains in the presacral space and receives nociceptive inputs from pelvic organs. Chronic perineal pain (CPP) in patients with advanced cancer can be very debilitating. Ganglion impar block can ameliorate CPP and hence, improve quality of life.
Here, we describe the case of a 65-year-old woman with a deformed coccyx caused by childhood trauma and rectal resection from rectal cancer who presented with CPP that substantially affected her quality of life. She was unable to tolerate the side effects of World Health Organization Step 3 analgesics. The patient underwent ganglion impar block that was challenging due to anatomical abnormalities. There was significant immediate and long-term improvement in quality of life and disease coping in our patient after the ganglion impar block. She was able to restore physical activity, decrease the need for potent opioids, and improve sleep quality.
We conclude that a ganglion impar block can effectively treat CPP, and in palliative settings, neurolytic ablation can be considered. It is often challenging in patients with cancer due to anatomical abnormalities. Further studies are needed in patients with cancer who have CPP given the suggestion of a better quality of life after ganglion impar block.
Key words: Ganglion impar, chronic perineal pain, quality of life, cancer pain, coccyx