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Pelvic fascia (Fig. 24.1)
gains access to the rectus sheath, which it supplies, and eventually
The pelvic fascia is the term given to the connective tissue that lines the
anastomoses with the superior epigastric artery.
pelvis covering levator ani and obturator internus. It is continuous with
• Internal iliac artery: courses from its origin (described above)
the fascial layers of the abdominal wall above and the perineum below. cumflex iliac artery and inferior epigastric artery. The latter branch
Endopelvic fascia is the term given to the loose connective tissue that to divide into anterior and posterior trunks at the level of the greater
covers the pelvic viscera. The endopelvic fascia is condensed into fas- sciatic foramen.
cial ligaments which act as supports for the cervix and vagina. These
ligaments include the: Branches of the anterior trunk
• Cardinal (Mackenrodt’s) ligaments: pass laterally from the cervix • Obturator artery: passes with the obturator nerve through the obtur-
and upper vagina to the pelvic side walls. ator canal to enter the thigh.
• Utero-sacral ligaments: pass backwards from the cervix and va- • Umbilical artery: although the distal part is obliterated the proximal
ginal fornices to the fascia overlying the sacro-iliac joints. part is patent and gives rise to the superior vesical artery which con-
• Pubocervical ligaments: extend anteriorly from the cardinal liga- tributes a supply to the bladder.
ments to the pubis (puboprostatic in the male). • Inferior vesical artery: as well as contributing a supply to the blad-
• Pubovesical ligaments: from the back of the symphysis pubis to the der it also gives off a branch to the vas deferens (in the male).
bladder neck. • Middle rectal artery: anastomoses with the superior and inferior
rectal arteries to supply the rectum.
The broad and round ligaments (Fig. 24.2) • Internal pudendal artery: is the predominant supply to the per-
• Broad ligament: is a double fold of peritoneum which hangs ineum. It exits the pelvis briefly through the greater sciatic foramen but
between the lateral aspect of the uterus and the pelvic side walls. The then re-enters below piriformis through the lesser sciatic foramen to
ureter passes forwards under this ligament, but above and lateral to the enter the pudendal canal together with the pudendal nerve.
lateral fornix of the vagina, to gain access to the bladder. The broad liga- • Uterine artery: passes medially on the pelvic floor and then over the
ment contains the following structures: ureter and lateral fornix of the vagina to ascend the lateral aspect of the
• Fallopian tube. uterus between the layers of the broad ligament.
• Ovary. • Inferior gluteal artery: passes out of the pelvis through the greater
• Ovarian ligament. sciatic foramen to the gluteal region which it supplies.
• Round ligament (see below). • Vaginal artery.
• Uterine and ovarian vessels.
• Nerves and lymphatics. Branches of the posterior trunk
• Round ligament: is a cord-like fibromuscular structure which is the • Superior gluteal artery: contributes a supply to the gluteal muscles.
female equivalent of the gubernaculum in the male. It passes from the It leaves the pelvis through the greater sciatic foramen.
lateral angle of the uterus to the labium majus by coursing in the broad • Ilio-lumbar artery.
ligament and then through the inguinal canal (p. 30). • Lateral sacral artery.
Arteries of the pelvis (Fig. 24.3) Veins of the pelvis
• Common iliac arteries: arise from the aortic bifurcation to the left of The right and left common iliac veins join to form the inferior vena
the midline at the level of the umbilicus. These arteries, in turn, bifur- cava behind the right common iliac artery but anterolateral to the body
cate into external and internal iliac branches anterior to the sacro-iliac of L5. The overall arrangement of pelvic venous drainage reciprocates
joints on either side. that of the arterial supply.
• External iliac artery: courses from its origin (described above) to
become the femoral artery as it passes under the inguinal ligament at Nerves of the pelvis
the mid-inguinal point. The external iliac artery gives rise to branches Sacral plexus (see p. 100).
which supply the anterior abdominal wall. These include the: deep cir-

The pelvis IIbthe contents of the pelvis 57