Pelvic Musculature, Vasculature, Innervation, and Structures

Vasculature

• Bifurcation of the aorta
  • Superior hygogastric plexus (mostly parasympathetic fibers)
  • Right and left hypogastric nerves
  • Anterior vertebral body of L5; splits into hypogastric nerves coursing down towards rectum
  • Middle sacral artery
    
• Common Iliac Artery
• External iliac artery
  • Deep circumflex iliac artery;
  • cremasteric artery; br. of inferior epigastric
  • inferior epigastric artery; br. from ext. iliac a. immediately above inguinal ligament
  • deep ring; contains inf. epigastric medial to spermatic cord
  • vas deferens; within spermatic cord
  • round ligament; within deep ring
• internal iliac artery
• Iliolumbar artery
  • ala of the sacrum
  • lumbosacral trunk; superficial to lumbosacral trunk, deep to obturator nerve (and sometimes L4)
  • lateral 5th vertebral body
  • anastomose deep femoral circumflex artery
• Lateral Sacral artery
  • ventral ramus S1; anterior to
  • anterior sacral foramen; enters anterior sacral foramen with S1
• Sacral sympathetic trunk
  • grey ramus; coursing posterior and lateral to sympathetic trunk
  • sacral splanchnic (not easily seen); coursing anterior and medial towards sympathetic trunk
  • anterior surface of coccyx
  • ganglion impar - not often seen; meeting of R. and L. sympathetic trunks near coccyx
• Superior gluteal artery
  • posterior division internal iliac artery
    
  • lumbosacral trunk; lateral to
  • ventral ramus S1; medial to
  • sacral plexus
  • piriformis; exits pelivs superior to
• Inferior gluteal artery
  • internal pudendal artery; exits pelvis inferior to piriformis, anterior to inf. gluteal???
  • piriformis; exits pelvis between S2 S4 inferior to
    
• Internal pudendal artery
  • ischial spine; crosses over ischial spine, covered by gluteus maximus, posterior (lateral?) to sacrotuberous ligament
  • ischiococcygeus; posterior to coccygeus
  • sacrospinous ligament; posterior to?? (posterior/lateral to sacrotuberous ligament???)
  • pudendal nerve; medial to int. artery (obturator is lateral to artery)
  • sacral plexus; anterior to
  • inferior gluteal artery; common trunk
    
• Obturator artery
  • obturator canal
  • arcus tendineus; lateral to??
  • pectineal ligament
  • pubococcygeus; lateral to?
  • iliococcygeus; lateral to?
• Uterine artery
  • lateral sacral ligament (Cardinal); contained within
  • cervix; from hypogastric, across levator ani, towards cervix
  • ureter; crosses anterior and superior to, also gives br. to
  • ascending branch; up to uterus
  • descending branch; down to vagina?
• Umbilical artery
  • superior vesicle artery
  • medial umbilical ligament and fold; term of sup. vesicle a. (oblit)
• Middle rectal artery; br. from int. pudendal a.
• Vaginal artery; br. from inf. vesicle art.
• Inferior vesicle artery; gives off uterine a. and vaginal a.
• Nerve to levator ani; br. of S4??
• Gonadal vessels
  • testicular/ovarian plexus; abdominal aorta, just below renal arteries
  • IVC; anterior to
  • upper lumbar nodes;
  • suspensory ligament of the ovary; course through
    
  • left renal vein
  • abdominal aorta
  • superior pole of ovary; supplies
• ischiococcygeus
  • ischial spine; origin of
  • sacrospinous ligament; origin of

Musculature

• Obturator internus
  • arcus tendineus; specialization of fascia medial to
  • pudendal canal;
  • obturator canal
    
  • ischiorectal fossa
  • pelvis
• Piriformis
  • Ventral rami of S1-4; anterior to
  • greater sciatic foramen; exits through to insert onto greater troch.
  • anterior sacrum; origin
  • anterior sacral foramina
• Ischiococcygeus
  • ischial spine; origin
  • coccyx; insertion
  • sacrospinous ligament; origin
  • posterior wall pelvis
• Pubococcygeus
  • pubic bone; origin
  • anococcygeal raphe; insertion
  • levator ani
    
• Iliococcygeus
  • arcus tendineus; origin
  • levator ani
  • anococcygeal raphe; insertion
• Puborectalis
  • levator ani
  • puborectal sling; insertion, of sorts, originating from pubis
  • rectoanal junction
  • levator ani
• Iliacus
  • false pelvis

Innervation

• Superior hypogastric plexus
  • bifurcation of the aorta
  • anterior body of L5
  • right and left hypogastric nerves
  • presacral space
• Inferior hypogastric plexus
  • presacral (retrorectal) space
  • rectum
  • pelvic splanchnics
  • sacral splanchnics
  • right and left hypogastric nerves
    
• Sacral sympathetic trunk
  • sacral promontory
  • lumbar sacral sympathetic trunk
  • anterior sacral foramina
  • anterior surface of coccyx
  • ganlion impar (not typically seen)
    
  • gray ramus
  • sacral splanchnic (not easily seen)
• Pelvic splanchnic
  • about 1" long
  • S2-4 ventral rami
    
  • anterior sacral foramina
  • inferior hypogastric plexus
• Sacral Plexus
  • lumbosacral trunk
  • Ventral rami S1-4
  • superior gluteal nerve
  • inferior gluteal nerve
  • pudendal nerve
  • sciatic nerve
  • posterior femoral cutaneous
  • piriformis

Structures

• Pectineal ligament
  • obturator artery
  • obturator canal
  • femoral canal
  • lacunar ligament
• femoral ring
  • lacunar ligament
  • inguinal ligament
  • pectineal ligament
  • femoral vein
• Uterus and adnexia
  
  • ovary
  • suspensory ligament
  • obturator nerve
    
  • round ligament
  • deep ring
  • ovarian ligament
    
  • mesovarium
  • mesosalpinx
  • mesometrium
    
  • uterine tube
  • cervix
  • posterior fornix vagina
    
  • broad ligament
  • external os
  • internal os
  • uterine artery
  • ovarian artery
    
• Vagina
  • posterior fornix
  • perineal body (not in pelvis)
    
  • external anal sphincter (not in pelvis)
    
  • pubosacral ligamentous complex
• Bladder
  • detrusor
  • interureteric fold
  • trigone
  • uvula
• Rectum
  • left rectal folds
  • right rectal fold
  • anal canal (not in pelvis)
  • anal colum
  • anal valve
  • dentate line
  • presacral space
  • rectovesicle space
  • rectouterine pouch (of Douglas)
    
• Prostate
  • perivisceral fascia
  • rectovesical space
  • fascia of Denonvillae (sp)
  • uvula
  • urethral crest
  • seminal colliculus
  • prostatic sinus
• Puboprostatic or Pubovesicle ligament
  • inferior pubic rami
  • neck of bladder or prostate
  • condensation of pelvic visceral fascia
• Arcus tendineus
  • iliococcygeus
  • pubococcygeus
  • obturator canal
  • ischial spine
  • obturator fascia
  • levator ani
  • ischiococcygeus (not part of levator ani)
• Anococcygeal raphe
  • pubococcygeus
  • iliococcygeus
  • puborectalis (not attached)
  • floor of pelvis
• Pelvic diaphragm
  • superior fascia pelvic diaphragm and parietal pelvic fascia (not dissectable apart)
  • arcus tendineus
  • obturator canal
  • ischial spine
  • levator ani
  • ischiococcygeus (not part of levator ani)
  • nerve to levator ani (don't spend much time but we could tag it)
    • I just heard from a student who gradurated 11 years ago. He still complains that we tagged nerve to levator ani.
      

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