Expansion
Foregut epigastric, midgut periumbilical, hindgut suprapubic
Expansion
| Gut segment | Pain felt | Spinal level |
|---|---|---|
| Foregut - stomach to mid-duodenum, liver, gallbladder, pancreas, spleen | Epigastrium | T6 to T9 |
| Midgut - mid-duodenum to two-thirds along the transverse colon | Periumbilical | T10 |
| Hindgut - distal transverse colon to upper rectum | Suprapubic | T11 to L2 |
Visceral pain is felt in the midline because the gut is a midline structure with bilateral autonomic innervation.
This is why appendicitis starts periumbilically, why biliary colic and peptic ulcer pain are epigastric, and why the pain of diverticular disease and large bowel obstruction is suprapubic.
Pain shifts and localises only when the parietal peritoneum is involved, which is why migration of pain is such a valuable diagnostic feature.