The celiac plexus is the largest autonomic plexus in the body, surrounding the celiac trunk at the level of T12-L1. It is formed by the greater (T5-T9), lesser (T10-T11), and least (T12) splanchnic nerves along with parasympathetic fibres from the vagus nerve. The plexus gives rise to secondary plexuses accompanying the branches of the celiac trunk, providing sympathetic and parasympathetic innervation to most of the abdominal viscera from the stomach to the mid-transverse colon.
Celiac plexus neurolysis (CPN) is performed for intractable pain from upper abdominal malignancy, particularly pancreatic cancer, where tumour invasion of the celiac plexus produces severe epigastric and back pain. Alcohol or phenol is injected under CT or endoscopic ultrasound guidance on either side of the aorta at the celiac trunk level. The procedure reduces opioid requirements and improves quality of life in pancreatic cancer patients. Complications include orthostatic hypotension from sympatholysis and rare aortic or spinal artery injury.
Perineural invasion of the celiac plexus produces severe epigastric and bilateral back pain radiating in a band-like distribution, treated with celiac plexus neurolysis with alcohol injection under CT or EUS guidance, reducing opioid requirements and pain scores in 70-90% of patients.
Rare but serious complications of celiac plexus neurolysis include spinal cord ischaemia from inadvertent injection near the artery of Adamkiewicz, retroperitoneal haematoma, and chemical peritonitis from alcohol leak, requiring careful technique and real-time imaging guidance.
