Computed tomography celiac trunk topography relating to celiac plexus block.

BACKGROUND AND OBJECTIVES

The celiac plexus is a dense autonomic network surrounding the celiac trunk. To block this plexus, the celiac trunk is a landmark for needle placement. Needles inserted at a distance from the midline, "walking off" the vertebra, may penetrate surrounding organs. We reviewed 200 computed tomography images to investigate the celiac trunk topography relating to the block.

METHODS

Two hundred computed tomography images across the celiac trunk were displayed. The celiac emergence level and celiac-aortic-vertebral anatomies were examined. On each image, 2 needle trajectories imitating walking-off technique were placed tangential to the vertebral body passing through the crus of the diaphragm on both sides: L-9s and L-4.5s (9 and 4.5 cm from the midline, respectively). The vital organs traversed by these lines were noted and analyzed.

RESULTS

Celiac emergence levels: T11-12, 6.5%; T12, 34%; T12-L1, 31%; L1, 28.5%. Aortic locations: 70% were anterior-left to and 29% were anterior-middle to the vertebra. Celiac runoffs: 63.5% from the aorta anterolaterally on the left, 36% from the midportion. Celiac-aortic-vertebral correlations showed a various distribution in groups; 88% L-9s and 64% L-4.5s on the right side, and 96% L-9s and 88% L-4.5s on the left side traversed different vital organs with various frequencies.

CONCLUSIONS

The celiac trunk anatomy varies. Blocking needles walking off the vertebra from a fixed distance frequently traverse vital organs. Previewing celiac-aortic-vertebral topography with a simulating block on individual patient's computed tomography (CT) image for accordant needle placement subsequently is warranted.