J Korean Pain Soc.
1989 Nov;2(2):135-144.
Morphological Variations of the Celiac Plexus in Korean Cadavers
- Affiliations
-
- 1Department of Anesthesiology, Yonsei University, College of Medicine, Seoul, Korea.
- 2Department of Anatomy, Yonsei University, College of Medicine, Seoul, Korea.
Abstract
- Celiac plexus block is recommended in patients with intractable upper abdominal cancer pain. The success rate of a celiac plexus block is variable among the authors. One of the causes of this is the anatomical variations of the celiac plexus. There has not been a study concerning anatomical observations of the celiac plexus in Korean cadavers. So, anatomical dissections were performed and observations were made of the celiac plexus and related structures in Korean cadavers. The results were as follows: 1) The subjects were 21 male bodies and 5 female bodies. The mean age at death was 69.9+/-15.5 years (range 37-93). The mean height was 155.5+/-8.3 cm (range 143-172). 2) The number of celiac ganglia ranged from 1-4. The mean numbers were 2.3+/-1.9 in the right plexus and 1.9+/-0.8 in the left, and the mean sizes were 18.9+/-7.lx8.0+3.8mm2 and 18.5+/-8.3x9.5+/-3.9 mm2 respectively. 3) Celiac ganglia were most frequently located at the level of the upper third and middle third of Ll in both sides (65.5% in right, 64.0%. in left). The vertical range of celiac ganglia ranged from 1 space, which is one third the height of one vertebral body, to 4 spaces. Mean vertical ranges were l.5+/-0.6 spaces in the right plexus and 1.60+/-0.7 spaces in the left. The celiac ganglia located at the level of the upper third of Ll in the right and the lower third of Ll in the left side, had the largest vertical ranges respectively (1.8+/-0.5 spaces in right, 2.3+/-0.6 spaces in left). 4) Right side celiac ganglia were located near the midline of the vertebrae compared to the left ones (mean 5.0 mm). The horizontal dimension was greater in the right ganglia (24.2+/-9.2 mm) than in the left ganglia (18.8+/-7.0 mm). 5) There was no vertebral level difference between both celiac ganglia in most cases (60%). However, of the 40%. of cases at different levels, in half of these (20%) the right ganglia were located higher than the left ganglia; and in the other 20%, this was reversed. 6) The origin sites of the celiac artery were most frequently in the upper third and middle third of Ll (61.6%). The celiac ganglia were usually located at the same level as the site of origin of the celiac artery (61.6% in right. 52.0% in left). 7) The vertebral level of the splanchnic nerves piercing the abdominal surface of the diaphragm was most frequently in the upper third and middle third of Ll (66.6% in right. 66.7% in left). 8) The level of the origin of diaphragmatic crura from the anterior surface of the vertebral bodies varied from the Ll-L2 interspace to the L3-L4 interspace. Right crura most frequently originated at the level of the lower third of L2 to the upper third of L3 (57.69.), while left crura originated from the level of the L2-L3 interspace to the middle third of L3 (69.3%). From the above results, we realized that there were some anatomical variations of the celiac plexus and its relations to adjacent structures in Korean bodies. However, when the needle point is behind the anterior margin of the upper third of Ll, it is possible to perform a successful retrocrural splanchnic nerve block.
