Prevertebral ganglia (coeliac, aorticorenal, superior and inferior mesenteric)
Ganglion · Greater T5–T9 Lesser T10–T11 Least T12 Lumbar L1–L2
Ganglia clustered on the abdominal aorta at the origins of its unpaired branches. They receive splanchnic nerves that passed through the chain unsynapsed and give postganglionic fibres that follow the arteries to the gut, kidneys and pelvis. Visceral afferents travel the same route in reverse, explaining referred pain.
Traced from the start
- Sympathetic (thoracolumbar) outflow
- Intermediolateral cell column T1–L2 via white rami communicantes
- Prevertebral ganglia (coeliac, aorticorenal, superior and inferior mesenteric)
Detail
- Coeliac ganglion
- Greater splanchnic T5–T9 → foregut (stomach to major duodenal papilla, liver, spleen, pancreas) and adrenal medulla
- Aorticorenal and superior mesenteric
- Lesser T10–T11 and least T12 → kidney, ureter and midgut (to two-thirds of transverse colon)
- Inferior mesenteric ganglion
- Lumbar splanchnic L1–L2 → hindgut and, via the superior hypogastric plexus, pelvic viscera
- Referred pain map
- Foregut T5–T9 epigastrium; midgut T10–T11 periumbilical; hindgut L1–L2 suprapubic — afferents run with the splanchnic nerves
When it goes wrong
Intractable pain from pancreatic or upper abdominal cancer
Neurolytic coeliac plexus block relieves pain by ablating visceral afferents; orthostatic hypotension and diarrhoea follow the loss of sympathetic tone
Early appendicitis stretches the midgut and its T10 afferents
Vague periumbilical pain that localises to the right iliac fossa only when the parietal peritoneum (somatic T12–L1) becomes inflamed
Practise this structure
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