PELVIC VESSELS AND NERVES Introduction Definition Pelvis means

PELVIC VESSELS AND NERVES

Introduction Definition ü Pelvis means basin ü The bony pelvis consist of four bones united by four joints and two ligaments

Divisions of pelvis ü False pelvis ü True pelvis ü Walls of the true pelvis ü Pelvic viscera

It is a small vessel that arises posterior to the abdominal aorta and superior to its bifurcation. It descends in the middle line in front of fourth and fifth lumbar vertebrae, the sacrum and coccyx. Ø It supplies the back of rectum. Median Sacral Artery

“ Origin: The terminal branch of the inferior mesenteric is the superior rectal artery. Courses: Descends in to pelvic cavity in the sigmoid mesocolon, crossing the left sacroiliac joints to the middle of third sacral segments, which divides in to two lateral branches at recto-sigmoid junction. ” The superior is the principal artery of rectum. Superior Rectal Artery

Each artery arises from the common iliac artery opposite the lumbo-sacral articular disc and in front of the sarco-illac joints. The artery consist of a trunk and anterior & posterior divisions. Internal Iliac Arteries IT IS THE MAIN ARTERY OF THE PELVIS

Branches From The Anterior Divisions ü Superior Vesical Artery ü Inferior Vesical Artery ü Middle Rectal Artery ü Obturator Artery ü Uterine Artery ü Vaginal Artery ü Inferior Gluteal Artery ü Internal Pudendal Artery

q Superior Vesical Artery ü It is derived from the proximal part of the umbilical artery.

q Inferior Vesical Artery ü It arises either separately or in common with the middle rectal artery. ü The inferior vesical artery corresponds with the vaginal artery in females.

q Middle Rectal Artery ü Through the pelvic-rectal space within the lateral ligaments of the rectum

q Obturator Artery ü Latter anastomose with inferior epigastric artery ü (In 20%-30% leads to abnormal obturator artery)

q Uterine Artery

q Vaginal Artery ü The branches anastomose in front and behind of vagina and form anterior and posterior azygos arteries of the vagina

q Inferior Gluteal Artery ü Terminal branch ü Appears in gluteal region below the piriformis

q Internal Pudendal Artery Branches ü ü ü Inferior rectal artery Perineal branch Bulb of penis or vestibule Deep artery of penis or clitoris Dorsal artery of the penis or clitoris

q From posterior division Ø Ilio-lumbar artery Ø Superior gluteal artery Ø Lateral sacral arteries

In general corresponds with the branches of the internal iliac arteries except the umbilical and ilio-lumbar artery q PELVIC VEINS Parietal and visceral

Rectal venous plexus Vesico-prostatic plexus Utero-vaginal plexus

q Sacral plexus ü Formation : ventral rami of the fourth and fifth lumbar , and four sacral nerves. ü Roots from ( L 4, L 5, S 1, S 2, S 3 S 4) ü L 4 called Nervi furcalis

Transvaginal Pudendal nerve block

Abnormal obturator artery

Sciatic nerve injury

Internal and external haemorrhoids