Transcript 1. Pelvic splanchnic nerves

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Dr. Sama-ul-Haque
Dr. Rania Gabr
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 Describe the origin, termination, course and
branches of the internal iliac artery.
 Discuss the origin, site, relations, branches & their
final distribution of the sacral plexus.
 Discuss the anatomy of the autonomic supply of the
pelvic organs.
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 Common iliac artery divides
in front of the sacroiliac joint
into external and internal
iliac arteries.
 The Internal Iliac Artery
passes down into the pelvis.
 At the upper margin of
greater sciatic foramen it
divides into anterior and
posterior divisions.
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The Posterior division supplies the:
1- Posterior abdominal wall.
2- Posterior pelvic wall.
3- Gluteal region.
The Anterior division supplies the:
1. Pelvic viscera (Except Ovary).
2. Perineum.
3.Gluteal region.
4.Adductor (medial)region of the thigh.
5.The fetus (through the umbilical arteries)
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 1- Umbilical artery
 Gives the superior vesical artery
 The distal fibrous part of this artery becomes the
Medial Umbilical Ligament.
 2- Obturator artery: pelvic musc. , ms of med comp of
thigh, nutrient arts.
 3- Inferior vesical artery (Male)
 It supplies, the Prostate, inferior part of the bladder and
the Seminal Vesicles.
 It gives the artery to the Vas Deferens.
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 4- Middle rectal artery: supplies: Semin. vesicle,
prostate (vagina), inf part of the rectum
 5- 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.
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 6- Inferior gluteal artery: pelvic diaphragm, piriformis,
QF, upper hamstrings,Glut. Max. and Sciatic nerve
 7- Uterine artery (Female)
 Crosses the ureter superiorly
 Ascends in the layers of broad ligament of uterus
 Ends by anastomoses with ovarian artery
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8- Vaginal artery (Female): dividesinto:
1- vaginal: to vagina
2-inferior vesical : to urinary bladder
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Anteri
or
divisio
n
* Visceral Branches (in Female)
Vaginal artery:
Replaces the inferior
vesical artery.
Uterine artery:.
Crosses the Ureter
superiorly and supplies
the uterus & uterine
tubes.
(B) Ovarian artery:
Arises from the abdominal
aorta.
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 1- Iliolumbar artery: ps. Major, quadr. Lumb,
iliacus,and cauda equina
 2- Lateral sacral artery: piriformis, erector spinae and
skin over, str. In sacral canal
 3-Superior gluteal artery: piriformis, gluteii, tensor
fascia lata
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Posteri
or
divisio
n
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*The pelvis is drained:
• 1- Mainly by the internal iliac veins
and their tributaries.
• 2- Superior rectal veins
• 3- Median sacral vein.
• 4- Gonadal veins.
• 5- Internal vertebral venous plexus
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*(A) Somatic:
* Sacral plexus
* From Ventral rami of a part of
L4 & whole L5 (lumbosacral
trunk) + S1,2,3 and most of S4.
* It gives Pudendal nerve to
perineum
* (B) Autonomic:
*1. Pelvic splanchnic
nerves (From S 2 , 3 & 4)
* They are the Preganglionic
parasympathetic nerves to
pelvic viscera & hindgut.
2. Sympathetic:
It is formed of:
(a) Pelvic part of sympathetic
trunks:
They are the continuation of the
abdominal trunks.
They Descend in front of the ala
of the sacrum &
terminate inferiorly
in front of the coccyx and form a
single ganglion (Ganglion Impar).
(b) Superior & Inferior
Hypogastric plexuses.
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Lies on the posterior pelvic wall in front of Piriformis
muscle.
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Formed from:
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The anterior rami of 4th & 5th lumbar nerves
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The anterior rami of 1st, 2nd, 3rd & 4th sacral nerves
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4th lumbar nerve joins the 5th lumbar nerve to form
Lumbosacral Trunk
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*Autonomic innervation of the pelvic
cavity is via four routes:
1- the sacral sympathetic trunks,
2- periarterial plexuses,
3- hypogastric plexuses: sup and inf,
and
4- pelvic splanchnic nerves.
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*The prevertebral plexus enters the pelvis as two
hypogastric nerves, one on each side, that cross the
pelvic inlet medially to the internal iliac vessels.
*The hypogastric nerves are formed by the separation
of the fibers in the superior hypogastric plexus, into
right and left bundles.
*The superior hypogastric plexus is situated anterior to
vertebra L5 between the promontory of the sacrum
and the bifurcation of the aorta.
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*When the hypogastric nerves are joined by pelvic
splanchnic nerves carrying preganglionic
parasympathetic fibers from S2 to S4, the pelvic
plexuses (inferior hypogastric plexuses) are formed .
*The inferior hypogastric plexuses, one on each side,
course in an inferior direction around the pelvic walls,
medially to major vessels and somatic nerves.
*They give origin to the following subsidiary plexuses,
which innervate the pelvic viscera:
1-the rectal plexus;
2-the uterovaginal plexus;
3-the prostatic plexus; and
4-the vesical plexus.
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