Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2022; 10(27): 9873-9878
Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9873
Resolution of herpes zoster-induced small bowel pseudo-obstruction by epidural nerve block: A case report
You-Cai Lin, Xiao-Guang Cui, Li-Zhu Wu, Dong-Qing Zhou, Qi Zhou
You-Cai Lin, Xiao-Guang Cui, Li-Zhu Wu, Dong-Qing Zhou, Qi Zhou, Department of Anesthesiology, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan Province, China
Author contributions: Lin YC and Cui XG conceived the idea to publish the case and provided images of certain diagnostic evaluations; Wu LZ contributed to the data collection and manuscript preparation; Zhou DQ analyzed the data; Lin YC contributed to the literature review; Zhou Q contributed to the conceptualization and supervision; All authors have read and approved the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Qi Zhou, MA, Assistant Professor, Chief Physician, Department of Anesthesiology, The First Affiliated Hospital of Hainan Medical University, No. 31 Longhua Road, Haikou 570102, Hainan Province, China.
Received: May 3, 2022
Peer-review started: May 3, 2022
First decision: June 8, 2022
Revised: June 30, 2022
Accepted: August 15, 2022
Article in press: August 15, 2022
Published online: September 26, 2022

When herpes zoster is complicated with paralytic ileus, this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon; small intestinal obstruction is rare. Here, we present a patient with a very rare case of small bowel pseudo-obstruction.


A 76-year-old female patient complained of right upper quadrant pain. Two days later, a blistering, right-sided rash of the thoracoabdominal dermatome (T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate. Computed tomography of the abdomen confirmed small bowel pseudo-obstruction. Antiviral therapy, gastrointestinal decompression, and enemas proved unproductive. After 4 d of stagnation, an epidural block was performed for pain relief and prompted the passage of gas and stool, resolving the obstructive problem. Three days later, the rash appeared dry and crusted, and the pain diminished. After 5 d, no abnormality was visible by gastroenteroscopy, and the patient was discharged on day 7.


This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction. Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.

Keywords: Herpes zoster virus, Ogilvie’s syndrome, Small bowel pseudo-obstruction, Epidural nerve block, Case report

Core Tip: In addition to pain, herpes zoster may also cause bowel pseudo-obstruction, mainly colonic pseudo-obstruction. We present a rare small bowel pseudo-obstruction caused by herpes zoster. In this case, the small bowel pseudo-obstruction was relieved when an epidural block was used to treat the pain. Here, we explain the effective mechanism of treatment. Given that sympathetic innervation of the small bowel occurs by way of the T9 and T10 branches, an epidural catheter inserted from T9-T10, local anesthetics effectively blocked the sympathetic nerves innervating the small bowel. We suggest to promote small bowel peristalsis, to expand small bowel blood vessels and to improve small bowel function to relieve small bowel pseudo-obstruction.