Pelvic Vessels and Nerves

1. Pelvic Vessels and Nerves Dr. Sama-ul-Haque Dr. Safaa Ahmed

2. Objectives

3. Internal Iliac Artery • Common iliac artery divides in front of the sacroiliac joint into external and internal Iliac Arteries. • Internal Iliac Artery passes down into the pelvis. • At the upper margin of greater sciatic foramen it divides into anterior and posterior divisions.

4. Internal Iliac Artery

5. Branches of Anterior division of Internal Iliac Artery • Umbilical artery • Superior vesical artery • Obturator artery • Inferior vesical artery (Male) • Artery to the vas deferens • Supplies base of bladder, prostate & seminal vesicle

6. Branches of Anterior division of Internal Iliac Artery • Middle rectal artery • Internal pudendal artery • Leaves pelvis through greater sciatic foramen • Enters perineum by passing through lesser sciatic foramen • Enters into pudendal canal with pudendal nerve • Supplies anal canal musculature, skin & muscles of perineum.

7. Branches of Anterior division of Internal Iliac Artery • Inferior gluteal artery • Uterine artery (Female) • Runs on the pelvic floor • Crosses the ureter superiorly • Ascends in the layers of broad ligament of uterus • Ends by anastomoses with ovarian artery • Vaginal artery (Female)

8. Branches of Anterior division of Internal Iliac Artery

9. Branches of Posterior division of Internal Iliac Artery • Iliolumbar artery • Lateral sacral artery • Superior gluteal artery

10. Branches of Posterior division of Internal Iliac Artery

11. Sacral Plexus • Lies on the posterior pelvic wall in front of Piriformis muscle. • Formed from: • The anterior rami of 4th & 5th lumbar nerves • The anterior rami of 1st, 2nd, 3rd & 4th sacral nerves • 4ht lumbar nerve joins the 5th lumbar nerve to form Lumbosacral Trunk

12. Sacral Plexus

13. Sacral Plexus

16. Autonomic Nerves

17. Autonomic Nerves

18. Superior and Inferior Hypogastric Plexus

19. Nerve: • The pelvis is innervated chiefly by the sacral and coccygeal spinal nerves and by the pelvic part of the autonomic nervous system. • Sacral and Coccygeal Plexuses. • The sacral plexus, which lies in front of the piriformis, supplies the buttock and lower limb as well as structures belonging to the pelvis. • It is formed by the lumbosacral trunk, the ventral rami of S1 to 3, and the upper division of S4. • The pudendal nerve (S2 to 4) supplies most of the perineum. • It contains motor, sensory (pain and reflex), and postganglionic sympathetic fibers. • It can be "blocked" medial to the ischialtuberosity, e.g., during parturition.

20. Pelvic Part of Autonomic Nervous System: • The pelvic splanchnic nerves: • The pelvic splanchnic nerves (S2 to 4) contain parasympathetic preganglionic and sensory fibers. • They help to form the inferior hypogastric plexus. • Sympathetic fibersreach the pelvis by downward continuations of the sympathetic trunks and of the aortic plexus. • The aortic plexus is continued as the superior hypogastric plexus which divides in front of the sacrum into right and left hypogastric nerves. • The hypogastric nerves descends&unites with the pelvic splanchnic nerves to form the right and left inferior hypogastric plexuses , which give branches to the pelvic viscera (e.g., the rectum, bladder, and uterus).

21. The inferior hypogastricplexuses contain: • (1) Postganglionic sympathetic fibers. • (2) Preganglionic parasympathetic fibers, which supply the descending and sigmoid colon and the pelvic viscera. • (3) Sensory fibers including : • Pain fibers (many of which travel in the lumbar splanchnic nerves) • Reflex fibers from the bladder (which ascend in the pelvic splanchnic nerves).

22. Thank You