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TEST TAKING TIP

Test Taking Tip

Remember to review the management of tubo-ovarian abscesses and the physiologic changes of the pregnant patient during each of the trimesters.

FIGURE 30-1.

The muscles and vasculature of the pelvis. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

ANATOMY

What are the branches of the internal iliac artery (hypogastric)?

  • Posterior division: Iliolumbar, lateral sacral, superior gluteal

  • Anterior division: Obturator, internal pudendal, inferior gluteal, umbilical, middle vesicle, inferior vesicle, middle hemorrhoidal, uterine, vaginal

Arterial supply to the uterus:

  • Uterine artery from the hypogastric and ovarian arteries directly from the aorta

Right ovarian vein originates from:

  • Inferior vena cava

Left ovarian vein originates from:

  • Left renal vein

Vaginal arterial supply

  • Upper: cervical branch of the uterine artery

  • Middle: inferior vesical

  • Lower: internal pudendal and middle hemorrhoidal

The major arterial supply to the cervix is located:

  • In the lateral cervical walls at the 3 and 9 o'clock positions

The external pudendal artery supply:

  • The rectum, labia, clitoris, perineum

Artery that supplies the round ligament:

  • Sampson

Inferior epigastric artery and vein originates from:

  • External iliac artery and external iliac vein, respectively

Levator ani complex:

  • Iliococcygeus, pubococcygeus, puborectalis

Boundaries of the femoral triangle:

  • Sartorius, adductor longus muscle, and inguinal ligament

Floor of the femoral triangle is formed by:

  • Iliopsoas, pectineus, and adductor longus

FIGURE 30-2.

The avascular spaces of the female pelvis. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Space of Retzius:

  • The area between the bladder and the symphysis pubis, bounded laterally by the obliterated hypogastric arteries

Cul-de-sac of Douglas:

  • Also known as the rectouterine pouch or fold and is located anterior to the rectum, separating the uterus from the large intestine

Boundaries of the paravesical space:

  • Anterior: pubic symphysis

  • Posterior: cardinal ligament

  • Medial: superior vesical artery

  • Lateral: obturator internus muscle

Boundaries of the pararectal space:

  • Anterior: cardinal ligament

  • Posterior: sacrum

  • Medial: rectum

  • Lateral: iliac vessels

    ...

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