OBJECTIVE: This report describes a case of computed tomography (CT)-guided bilateral posteromedian transdiscal approach to the superior hypogastric plexus with neurolysis for treatment of intractable abdominal pain secondary to metastatic prostate cancer. The case is considered in relation to other approaches described in the literature. DESIGN: Case presentation and literature review. PATIENTS: An 83-year-old man with metastatic prostate cancer and intractable abdominal pain. INTERVENTIONS: Computed tomography-guided bilateral posteromedian transdiscal neurolysis of the superior hypogastric plexus. RESULTS: Pain reduction for intractable metastatic prostate cancer abdominal pain. CONCLUSIONS: Neurolysis of the superior hypogastric plexus is effective in treating metastatic prostate cancer abdominal pain. While there are significant risks to the CT-guided bilateral transdiscal approach to the superior hypogastric plexus, it may be used effectively as an alternative to navigate anatomic obstacles necessary to perform the neurolysis.