Case Report: A Challenging Superior Hypogastric Plexus Block in a Patient with Enlarged and Bifid Transverse Processes.

Introduction: Superior hypogastric plexus block (SHPB) is an established treatment for chronic pelvic pain (CPP). Anatomical variations can significantly complicate interventional pain procedures. Case Presentation: We present a case of a 44-year-old woman with CPP secondary to endometriosis and unique lumbosacral (L-S) anatomy, including enlarged and bifid transverse processes, which posed a challenge to standard SHPB techniques. This necessitated a tailored approach to ensure success and patient safety. Successful bilateral blockade was achieved using a combination of posterolateral and trans-discal approaches under fluoroscopic guidance. The patient reported substantial pain relief and improved quality of life. Conclusions: This case underscores the clinical relevance of recognizing and adapting to anatomical variations during SHPB to optimize procedural success and patient outcomes. Despite the limitations inherent in its retrospective design and reliance on existing clinical data, this study reinforces the need for individualized approaches in similar interventions.