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Celiac Plexus Block
Jennifer R. Buckley, MD; Brandt C. Wible, MD
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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 IVC 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 approximately 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
                • 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 the 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

                                    1. 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):204-209, 2016
                                    2. 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
                                    3. Minaga K et al: Acute spinal cord infarction after EUS-guided celiac plexus neurolysis. Gastrointest Endosc. 83(5):1039-40; discussion 1040, 2016
                                    4. 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
                                    5. Edelstein MR et al: Pain outcomes in patients undergoing CT-guided celiac plexus neurolysis for intractable abdominal visceral pain. Am J Hosp Palliat Care. ePub, 2015
                                    6. 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 IVC 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 approximately 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
                                                  • 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 the 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

                                                                      1. 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):204-209, 2016
                                                                      2. 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
                                                                      3. Minaga K et al: Acute spinal cord infarction after EUS-guided celiac plexus neurolysis. Gastrointest Endosc. 83(5):1039-40; discussion 1040, 2016
                                                                      4. 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
                                                                      5. Edelstein MR et al: Pain outcomes in patients undergoing CT-guided celiac plexus neurolysis for intractable abdominal visceral pain. Am J Hosp Palliat Care. ePub, 2015
                                                                      6. 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