Mennat Allah Saqr

Lecturer of Anatomy and Embryology

Bony Pelvis
Bony pelvis

Hip bone

sacrum
Articulated pelvis
pelvic surface gluteal surface
Muscle attachment
Sacrum (pelvic surface)
Sacrum (Post view)
Sacrum (Lat. view)
Articulated pelvis
Pelvic inlet
Pelvic outlet
ligaments
ligaments
Supraspinous ligament Posterior sacro-iliac ligaments

Sacrospinous ligament
Sacrotuberous ligament

Iliolumbar ligament
Anterior longitudinal ligament

Anterior sacro-iliac ligament

Sacrospinous ligament

Sacrotuberous ligament
Joints
Soft pelvis
Soft pelvis

Muscles

Vessels

Nerves
Muscles

Obturator
Internus

Levator Ani

Piriformis
muscles Muscles
 Piriformis muscle
Piriformis muscle

Medial view Lateral view

 Obturator internus muscle
Obturator internus muscle

Tendinous arch of levator ani muscle

(white line)

obturator fascia (cut)

Medial view Lateral view

Obturator internus muscle
Levator ani
 Levator ani
Urethra

Vagina Puborectalis muscle

Levator ani
Pubococcygeus muscle muscle
Rectum
Iliococcygeus muscle
Tendinous arch
(white line) Obturator internus
Obturator fascia muscle
Coccygeus muscle

Piriforms
muscle
Coccyx
Median raphe of levator ani
Anterior sacrococcygeal lig. (levator plate)

Sacral promontory

Superior view (female)

 Urethral hiatus

Ano-rectal hiatus
Tendinous arch
(white line) Puborectalis muscle
Obturator fascia Levator ani
Pubococcygeus muscle muscle
Iliococcygeus muscle
Obturator internus
muscle
Coccygeus muscle
Piriforms muscle

Superior view (male)

 Urethra

Vagina

Rectum Puborectalis muscle

Levator ani
Tendinous arch Pubococcygeus muscle muscle
(white line)
Iliococcygeus muscle

Obturator internus
Obturator internus muscle
tendon
Piriformis muscle

Coccygeus muscle
(ischiococcygeus)
Median raphe of levator ani
Piriformis muscle
(cut)

Inferior view (female)

 Urethral hiatus

Anorectal hiatus
Puborectalis muscle
Levator ani
Tendinous arch Pubococcygeus muscle muscle
(white line)
Iliococcygeus muscle

Obturator internus Obturator internus m

tendon
Gluteus maximus m
Coccygeus muscle Median raphe of levator ani
(ischiococcygeus)
Piriformis muscle
(cut)

Inferior view (male)

 Arrangement of pelvic structures

Paramedian (sagittal) dissection Median (sagittal) dissection

Arrangement of pelvic structures

Superior view
 Arrangement of pelvic structures
Urinary bladder
Vesico-uterine pouch
uterus

cervix

Recto-uterine pouch
(of Douglas)

Rectum

Sacral promontory

Superior view with peritoneum intact Superior view with peritoneum (uterus removed)
 Arrangement of pelvic structures
Urinary bladder
Rectovesical pouch
Rectum

Sigmoid colon

Sacral promontory

Body of L3 vertebra

Ascending colon
Ascending colon
Superior view (male) with peritoneum intact
 Arteries and Veins of Pelvic Organs

Male
Female
 Vessels Lumbar branch

Spinal branch

Iliolumbar artery
Posterior division
1- Iliolumbar artery.
2- Two lateral sacral arteries. Lateral sacral arteries

3- Superior gluteal artery.

Superior gluteal artery

Branches of the posterior trunk of the internal iliac artery

 Vessels
Anterior division branches
A)parietal branches:
1- obturator artery.
2- inferior gluteal artery.
3- internal pudendal artery.
B) visceral branches:
1- umbilical artery and its superior
vesical branch.
2- inferior vesical artery (in male)
(Replaced by vaginal artery in
female).
3- uterine artery (in female).
4- middle rectal artery.
Pelvic lymphatic drainage
Nerves (sacral plexus)
Nerves (sacral plexus)
 Branches of sacral plexus
A) from the roots of the plexus:
Ventral branches:
1- Pudendal nerve (S2, 3, 4).
2- Pelvic splanchnic nerve (S2, 3, 4), gives parasympathetic supply to pelvic
organs.
3- Perineal branch of S4 (supply external anal sphincter).
Dorsal branches:
4- Nerve to Piriformis (S1,2)
5- Posterior cutaneous nerve of thigh (S2, 3).
6- Perforating cutaneous nerve (S2, 3).
B)From the plexus itself:
Ventral branches:
1- Nerve to quadrates femoris (L4, 5-S1).
2- Nerve to obturator internus (L5- S1, 2).
3- Tibial part of sciatic nerve (L4,5-S1,2,3)
Dorsal branches:
4- Superior gluteal nerve (L4, 5-S1).
5- Inferior gluteal nerve (L5- S1, 2).
6- Common peroneal part of sciatic nerve (L4,5-S1,2)
Two terminal branches are pudendal & sciatic nerves.
 Nerves )Pelvic sympathetic chain)

Branches:
1. Grey rami communicants (postganglionic
fibers) to join all sacral and coccygeal
nerves.
2. Branches to inferior hypogastric plexus.
3. Vascular branches to the arteries of
perineum & lower limb