Celiac plexus: Largest visceral nerve network, which provides sympathetic, parasympathetic, and visceral sensory afferent fibers to upper abdomen
Main target of pain signals in upper abdominal organs
Pain from organ → visceral afferent fibers → celiac plexus → splanchnic nerves → spinal cord
Serves pancreas, liver, biliary tract, gallbladder, spleen, adrenals, kidneys, mesentery, stomach, and bowel proximal to transverse colon
Bilateral retroperitoneal celiac ganglion within antecrural space, anterolateral to aorta
94% located at level of T12 or L1
0.5-1.0 cm below celiac artery
Location of celiac artery, not vertebral body level, considered most reliable landmark for celiac plexus
Left celiac ganglion: Anteromedial to left adrenal, between adrenal and left diaphragmatic crus
Slightly more caudal than right in most cases
Visualized in up to 89% by CT
Right celiac ganglion: Anteromedial to right adrenal, between inferior vena cava and right diaphragmatic crus
Visualized in up to 67% by CT
Imaging appearance
Multilobulated structures similar to limbs of adrenal glands, averaging 2.7 cm in length
CT
Unenhanced and portal venous phases: Isoattenuating to adrenal glands
Delayed phase (10 min post contrast): Hyperattenuating to adrenal glands
US: Hypoechoic, multilobulated structures or small spheres with hypoechoic bands
Splanchnic nerves: Paired visceral nerves, which transmit pain information from celiac plexus to spinal cord
Greater splanchnic nerves (T5-T9), lesser splanchnic nerves (T10-T11), and least splanchnic nerves (T12)
Located within retrocrural space at ~ same level as celiac plexus
Hypogastric plexus: Responsible for pain transmission from bowel distal to transverse colon as well as pelvic organs
Explains why disruption of celiac plexus only results in upper abdominal visceral denervation
Celiac plexus neurolysis: Permanent destruction of celiac plexus, usually via direct injection of ethanol, resulting in disruption of pain transmission from upper abdominal viscera due to irreversible neuronal damage
Generally used for palliative pain control in patients with upper abdominal malignancies, including pancreatic cancer
Most commonly performed via CT-guided percutaneous technique
Celiac plexus block: Temporary disruption of celiac plexus via direct injection of corticosteroids or long-acting anesthetics, resulting in pharmacologic block of pain transmission from upper abdominal viscera without neuronal damage
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things To Do
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Edelstein MR et al: Pain outcomes in patients undergoing CT-guided celiac plexus neurolysis for intractable abdominal visceral pain. Am J Hosp Palliat Care. 34(2):111-4, 2017
Wyse JM et al: Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis. Endosc Ultrasound. 6(6):369-75, 2017
Dolly A et al: Comparative evaluation of different volumes of 70% alcohol in celiac plexus block for upper abdominal malignsancies. South Asian J Cancer. 5(4):204-9, 2016
Liu S et al: MRI-guided celiac plexus neurolysis for pancreatic cancer pain: efficacy and safety. J Magn Reson Imaging. 44(4):923-8, 2016
Minaga K et al: Acute spinal cord infarction after EUS-guided celiac plexus neurolysis. Gastrointest Endosc. 83(5):1039-40; discussion 1040, 2016
Mulhall AM et al: Bilateral diaphragmatic paralysis: a rare complication related to endoscopic ultrasound-guided celiac plexus neurolysis. Ann Am Thorac Soc. 13(9):1660-2, 2016
Kambadakone A et al: CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. Radiographics. 31(6):1599-621, 2011
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
Celiac plexus: Largest visceral nerve network, which provides sympathetic, parasympathetic, and visceral sensory afferent fibers to upper abdomen
Main target of pain signals in upper abdominal organs
Pain from organ → visceral afferent fibers → celiac plexus → splanchnic nerves → spinal cord
Serves pancreas, liver, biliary tract, gallbladder, spleen, adrenals, kidneys, mesentery, stomach, and bowel proximal to transverse colon
Bilateral retroperitoneal celiac ganglion within antecrural space, anterolateral to aorta
94% located at level of T12 or L1
0.5-1.0 cm below celiac artery
Location of celiac artery, not vertebral body level, considered most reliable landmark for celiac plexus
Left celiac ganglion: Anteromedial to left adrenal, between adrenal and left diaphragmatic crus
Slightly more caudal than right in most cases
Visualized in up to 89% by CT
Right celiac ganglion: Anteromedial to right adrenal, between inferior vena cava and right diaphragmatic crus
Visualized in up to 67% by CT
Imaging appearance
Multilobulated structures similar to limbs of adrenal glands, averaging 2.7 cm in length
CT
Unenhanced and portal venous phases: Isoattenuating to adrenal glands
Delayed phase (10 min post contrast): Hyperattenuating to adrenal glands
US: Hypoechoic, multilobulated structures or small spheres with hypoechoic bands
Splanchnic nerves: Paired visceral nerves, which transmit pain information from celiac plexus to spinal cord
Greater splanchnic nerves (T5-T9), lesser splanchnic nerves (T10-T11), and least splanchnic nerves (T12)
Located within retrocrural space at ~ same level as celiac plexus
Hypogastric plexus: Responsible for pain transmission from bowel distal to transverse colon as well as pelvic organs
Explains why disruption of celiac plexus only results in upper abdominal visceral denervation
Celiac plexus neurolysis: Permanent destruction of celiac plexus, usually via direct injection of ethanol, resulting in disruption of pain transmission from upper abdominal viscera due to irreversible neuronal damage
Generally used for palliative pain control in patients with upper abdominal malignancies, including pancreatic cancer
Most commonly performed via CT-guided percutaneous technique
Celiac plexus block: Temporary disruption of celiac plexus via direct injection of corticosteroids or long-acting anesthetics, resulting in pharmacologic block of pain transmission from upper abdominal viscera without neuronal damage
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things To Do
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Edelstein MR et al: Pain outcomes in patients undergoing CT-guided celiac plexus neurolysis for intractable abdominal visceral pain. Am J Hosp Palliat Care. 34(2):111-4, 2017
Wyse JM et al: Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis. Endosc Ultrasound. 6(6):369-75, 2017
Dolly A et al: Comparative evaluation of different volumes of 70% alcohol in celiac plexus block for upper abdominal malignsancies. South Asian J Cancer. 5(4):204-9, 2016
Liu S et al: MRI-guided celiac plexus neurolysis for pancreatic cancer pain: efficacy and safety. J Magn Reson Imaging. 44(4):923-8, 2016
Minaga K et al: Acute spinal cord infarction after EUS-guided celiac plexus neurolysis. Gastrointest Endosc. 83(5):1039-40; discussion 1040, 2016
Mulhall AM et al: Bilateral diaphragmatic paralysis: a rare complication related to endoscopic ultrasound-guided celiac plexus neurolysis. Ann Am Thorac Soc. 13(9):1660-2, 2016
Kambadakone A et al: CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. Radiographics. 31(6):1599-621, 2011
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