Greater Splanchnic Nerve

nervus splanchnicus major

The greater splanchnic nerve is formed by preganglionic sympathetic fibres from the fifth to ninth thoracic sympathetic ganglia (T5-T9). It descends obliquely on the anterolateral surface of the vertebral column, pierces the diaphragmatic crus, and synapses in the celiac ganglion. It conveys sympathetic innervation to the foregut and midgut (stomach to transverse colon, liver, spleen, pancreas) and is the primary pathway for visceral pain from the upper abdominal organs.

Region: Chest

Clinical Relevance

Clinical Notes

The greater splanchnic nerve is the primary pain pathway for chronic upper abdominal visceral pain, particularly from pancreatic cancer and chronic pancreatitis. Splanchnic nerve neurolysis using alcohol or radiofrequency ablation, targeting the nerve as it passes through the diaphragmatic crura, is an effective alternative to celiac plexus block for pain management in pancreatic malignancy. The procedure can be performed endoscopically, percutaneously under CT guidance, or thoracoscopically.

Pathology

Common Injuries & Conditions

Splanchnic Neurolysis for Pancreatic Pain

Chemical neurolysis of the greater and lesser splanchnic nerves at the diaphragmatic crura, performed percutaneously under CT guidance or thoracoscopically, provides effective pain relief for pancreatic cancer and chronic pancreatitis, with potential complications of orthostatic hypotension and diarrhoea from sympatholysis.