PELVIC VESSELS &
NERVES
Pelvic vessels
[Link] iliac artery
4
[Link] median
sacral - from abdominal
aorta
3
1
[Link] superior
2
rectal – cont. of inferior
Mesenteric artery
[Link] arteries in
female - from
abdominal aorta
Internal Iliac Artery - Course
Passes sub-peritoneally in
front of sacroiliac joint
At greater sciatic foramen
divides into anterior and
posterior divisions
The anterior division
continues up to ischial
spine
The posterior division
passes downwards to the
greater sciatic foramen
Anterior division - branches
1. Obliterated umbilical
artery
2. Superior vesical artery
3. Inferior vesical artery
4. Middle rectal artery
5. Obturator artery
6. Inferior gluteal artery
7. Internal pudendal artery
8. Uterine artery
9. Vaginal artery
Obliterated Umbilical Artery
Continuation of internal
iliac in intra uterine life
Distal part- obliterates-
medial umbilical lig
Proximal part –persists-
superior vesical artery
Superior vesical artery
2 - 3 in no
Supplies – upper part
of urinary bladder,
terminal part of ureter
Accompanies the vas
deferens reaches the
testis – anastomose
with testicular artery
Inferior vesical artery
Supplies
Base of urinary
bladder
Terminal ureter
Seminal vesicle
Ampulla of vas-
deferens
Prostate
Corresponds with
vaginal artery in
female
Middle rectal artery
Seen in pelvic rectal
space within the
lateral ligament of
rectum
Supplies
Lower part of rectum
Twigs to bladder and
seminal vesicles
Obturator artery
Accompanied by obturator
vein and nerve in the obturator
foramen
Divides into anterior and
posterior division
With in the pelvis supplies
[Link] bladder
[Link] vessels to ilium
3.A pubic br-which anastomoses
with pubic br of inferior
epigastric artery
Abnormal Obturator Artery
Uterine artery
Course
Accompanies the
lateral side of pelvic
part of ureter
Reaches Supra vaginal
part of cervix
Crosses the ureter from
lateral to medial side
Passes upwards reaches
the broad ligament
Runs tortuously upwards
along the lateral margin
of body of uterus
Passes below the uterine
tube
Enters the ovary
through meso-ovarium
Ends by anastomosing
with ovarian artery
Vaginal
Passes downwards and
artery
medially to the vagina
Divides into several
branches
Anastomose with each
other in midline –
azygos artery of vagina
Supplies
Vagina
Urinary bladder
rectum
Inferior gluteal artery
One of the
terminal branch of
anterior division
LARGEST
BRANCH of
anterior division
Enters the gluteal
region thro’
greater sciatic
foramen
Internal pudendal artery
Other terminal branch
Leaves the pelvis thro’ greater
sciatic foramen
Crosses the dorsal surface of
ischial spine related medially
with pudendal nerve
Enters the perineum thro lesser
sciatic foramen
Passes through - Pudendal canal
Divides into deep and dorsal
artery of penis or clitoris
Branches of IPA
1. Inferior rectal
2. Perineal branch -
transverse perineal
and 2 posterior
scrotal or labial
arteries
3. Artery to the bulb of
penis or vestibule
4. Urethral arteries
5. Deep artery of penis
or clitoris
6. Dorsal artery of
penis or clitoris
Posterior division
1. Iliolumbar artery
2. Superior gluteal
artery
3. Lateral sacral artery
Iliolumbar
In front of ala of sacrum
artery
Divides into iliac and lumbar branches
Iliac br. - nutrient br. to ilium
Lumbar br.- spinal br. between L5 and
sacrum
Lateral sacral artery
Spinal brs – pelvic (anterior) sacral foramen
supplies the contents of sacral canal
Run downward and medially over sacral nerves
Superior gluteal artery
Largest br. Of posterior division
Passes through greater sciatic foramen & Appears
in the gluteal region
Recap
Median sacral artery
Arises from dorsal surface
of abdominal aorta
Passes in front of L5
vertebrae
It supplies
Rectum, posterior rectal
space
Spinal br. to pelvic sacral
foramina
Terminates in glomus
coccygeum
Internal iliac vein
Ascends posteromedial
to internal iliac artery
Joins with external iliac
vein to form common
iliac vein in front of
sacro iliac joint.
Tributaries correspond
with branches of
internal iliac artery
Internal iliac vein
NERVES OF PELVIS
SOMATIC
a. LUMBOSACRAL TRUNK
b. SACRAL PLEXUS
c. COCCYGEAL PLEXUS
AUTONOMIC NERVES
a. SACRAL SYMPATHETIC TRUNKS
b. INFERIOR HYPOGASTRIC PLEXUSES
LUMBOSACRAL TRUNK
Descending part of Ventral ramus of L4 and entire
Ventral ramus of L5.
Descends obliquely over the ala of
sacrum, and enters pelvis posterior
to pelvic fascia
Sacral plexus
Formation - ventral rami L4
(descending
part),L5,S1,S2,S3
Nervous furcalis-L4
Emerge from ventral sacral
foramina
Unite in front of piriformis
Deep to pelvic fascia in the
posterior wall of true pelvis.
BRANCHES
Totally-12
5-supply pelvis
7-supply gluteal and
lumbar region
BRANCHES
1. Nerves arising from
roots of plexus
a. Nerve to
piriformis(S1,S2)
b. To levator ani and
coccygeus (S3,S4)
c. Pelvic splanchnic
nerves (Nervi erigentes)
Constrict sphincter vesicae
and sphincter ani externus,
Dilates arteries of erectile
tissue during erection
BRANCHES
2. Terminal Branches
a. Sciatic nerve (L4,
L5, S1, S2, S3)
Common peroneal
nerve part (DD L4,
L5, S1, S2)
Tibial nerve part
(VD L4,L5,S1,S2,S3)
b. Pudendal nerve (VD
S2,S3,S4)
Sacral Plexus
Sciatic nerve:
Fusion of:
Common peroneal (fibular)
component
and Tibial component
Largest physical nerve in the body.
Sacral Plexus
Sciatic nerve:
Exits pelvis through greater sciatic
foramen:
Inferior to piriformis (usually).
Descends between gluteus maximus.
Between greater trochanter and
ischial tuberosity.
Lies on:
Ischium, gemelli, obturator internus,
quadratus femoris.
Pudendal nerve
Small terminal br of
sacral plexus
Ventral rami of S2,S3,S4
Course
Passes thro greater sciatic
foramen below the
piriformis
Dorsal surface of ischial
spine
Enters the pudendal canal
In the pudendal canal
it is accompanied by
pudendal vessels
Branches
Inferior rectal nerve
Perineal nerve
Dorsal nerve of
penis/clitoris
Inferior rectal nerve
Traverses the ischio anal
fossa from lateral to
medial side
Supplies
Sphincter ani externus,
Perianal skin
Anal canal up to pectineal
line
Perineal nerve
Given in the anterior
part of pudendal canal
Division-superficial
and deep
Deep - muscular
Superficial – sensory-
2posterior scrotal or
labial nerves
Dorsal nerve of penis /clitoris
Sensory nerve
Pierces the perineal
membrane
Enters the deep
perineal pouch
Supplies the skin of
penis, prepuce and
glans
Pudendal Block
BRANCHES
3. Arising from the
pelvic surface of plexus
a. Nerve to quadratus
femoris (VD L4, L5,
S1) – through greater
sciatic foramen,
anterior to sciatic
nerve
b. Nerve to obturator
internus (VD L5, S1,
S2)
between sciatic and
pudendal nerves.
THANK YOU!
