ARTERIAL SUPPLY OF ABDOMEN &

PELVIS
Anterolater
al
Abdominal
Wall

Cutaneous Arteries ( Deep & superficial ):

1.Musculophrenic Artery:

Origin:
Internal thoracic artery
Distribution:
(a) Superficial & deep abdominal wall of hypochondriac region.
(b) Anterolateral diaphragm.

2.Superior epigastric artery:

Origin:
Internal thoracic artery
Distribution:
(a) Rectus abdominis muscle
(b) Superficial & deep abdominal wall of epigastric & upper
umbilical regions.

3.10th & 11th posterior intercostals arteries:

Origin:
Aorta
Distribution:
(a).Superficial & Deep abdominal wall of lateral region.

4.Subcostal Artery:

Origin:
Aorta
Distribution:
(a).Superficial & deep abdominal wall of lateral region.

5.Inferior epigastric artery:

Origin:
External Iliac artery
Distribution:
(a).Rectus Abdominis muscle
(b).Deep abdominal wall of pubic & inferior umbilical regions.

6.Deep circumflex iliac artery:

Origin:
External Iliac artery
Distribution:
(a).Iliacus muscle
(b).Deep abdominal wall of inguinal region
(c).Iliac fossa

7.Superficial circumflex iliac artery:

Origin:
Femoral artery
Distribution:
(a).Superficial abdominal wall of inguinal region & adjacent anterior

thigh

8.Superficial epigastric artery:

Origin:
Femoral artery
Distribution:
(a).Superficial abdominal wall of pubic & inferior umbilical regions.

Penis

Scrotum

Testis
Epididymis
Esophagus
Stomach

(1).Internal pudendal artery gives off 3 branches which supply

the penis:
(i) Deep artery of penis
(ii) Dorsal artery of Penis
(iii) Artery of the bulb of penis.
(2).Femoral artery gives off the superficial external pudendal
artery which supplies the skin & fasciae of penis.
Posterior scrotal branches of the perineal artery, a branch
of internal pudendal artery
Anterior scrotal branches of deep external pudendal
artery, a branch of femoral artery
Cremestaric artery ,a branch of inferior epigastric artery
Testicular artery ( branch of abdominal aorta)
Testicular artery
Left gastric artery (branch of celiac trunk)
Left inferior phrenic artery
Along lesser curvature by :
Left gastric artery(br. of celiac trunk)
Right gastric artery ( br. of proper hepatic artery)
Along greater curvature by:
Right gastro-omental artery(right gastroepiploic artery),
branch of
gastroduodenal artery.
Left gastro-omental artery(left gastroepiploic artery),
branch of splenic artery.
Fundus:
5-7 short gastric arteries (branches of splenic artery)

Duodenum Upto the opening of bile duct:

Superior pancreaticoduodenal artery ( br.of
gastroduodenal artery)
Below the opening of bile duct:
Inferior pancreaticoduodenal artery (br.of superior
mesenteric artery).
Jejunum & Superior mesenteric artery
Ileum
(Lowest part of ileum is also supplied by Ileocolic artery)
Cecum
Anterior & posterior rectal arteries from the ileocolic artery
( Branch of superior mesenteric artery)
Appendix
Appendicular artery , branch of ileocolic artery

Ascending
colon
Transverse
colon
Descendin
g colon &
sigmoid
colon
Spleen
Pancreas
Liver
Bile duct

Gall
bladder &
cystic duct
Kidneys

Ileocolic artery
Right colic branches of superior mesenteric arteries
Middle colic artery (branch of superior mesenteric artery)
Left colic artery ( br.of inferior mesenteric artery)
Sigmoid arteries (br.of Inferior mesenteric artery)
Splenic artery
Pancreatic branches of splenic artery
Superior pancreaticoduodenal artery
Inferior pancreaticoduodenal artery
Liver receives blood
20-25% through hepatic artery
75-80% through portal vein
Cystic artery
Right phrenic artery
Posterior superior pancreaticoduodenal artery
Gastroduodenal artery
Cystic artery ( arise from right phrenic artery)
Renal artery divides to form various segmental arteries:
Superior segmental artery to Superior segment
Anterosuperior segmental artery to Anterosuperior
segment
Anteroinferior segmental artery to antero inferior segment
Inferior segmental artery to inferior segment
Posterior segmental artery to posterior segment of the
kidney

Ureters

Upper part Renal artery

Middle part- (i) Testicular/ovarian arteries
(ii) Abdominal aorta
(iii) Common iliac arteries
Lower part- (i) Vesical artery
(ii) Middle rectal artery
(iii) Uterine vessels

Suprarenal
Gland
Urinary
bladder

Superior suprarenal arteries (6-8) from inferior phrenic

arteries
Middle suprarenal arteries (1) from abdominal aorta
Inferior suprarenal arteries (1 from Renal artery)
Superior & Inferior vesical arteries (branches of anterior
trunk of internal iliac artery)
In females from uterine & vaginal arteries instead of
inferior vesical.
Obturator & Inferior Gluteal arteries ( additional supply to
bladder)

Male

Urethral artery arises from internal pudendal artery

urethra
Female
urethra
Rectum

Anal canal
Ovaries &
Uterine
tubes
Uterus
Vagina

Ductus
deferens
Prostate
gland

Dorsal penile artery via circumflex branches on each side

Superior vesical arteries
Vaginal arteries
Superior rectal artery continuation of inferior
mesenteric artery
Middle rectal arteries arise from anterior division of
internal iliac artery
Median sacral artery small branch arising from back of
aorta
Above pectinate line superior rectal artery
Below pectinate line Inferior rectal artery
Ovarian arteries (arise from abdominal aorta)
Tubal branches of uterine arteries ( Branch of internal iliac
arteries)
Uterine arteries
Ovarian arteries
Vagina branch of internal iliac artery
In addition
The upper part is supplied by cevicovaginal branch of
uterine artery.
Lower part by middle rectal & internal pudendal arteries.
Branches of these arteries anastomose to form anterior &
posterior midline vessels called the vaginal azygos arteries.
Artery to ductus deferens ( arises from one of the terminal
branches of superior vesical artery but occasionally arises from
inferior vesical artery)
Supplied by branches from
Inferior vesical
Middle rectal
Internal pudendal arteries
These arteries form a large outer or subcapsular plexus,
and a small inner or periurethral plexus. Greater part of
gland is supplied by subcapsular plexus.

Reference: K.L.M & B.D chaurasia

VENOUS DRAINAGE OF ABDOMEN

& PELVIS
Anterolatera
l abdominal
wall
Penis

Scrotum
Testis

Venous drainage passes above mainly into axillary

vein via lateral thoracic vein.
Venous drainage passes below mainly into femoral
vein via superficial epigastric & great saphenous vein.
Superficial dorsal vein:
Drain prepuce & penile skin
Open into external pudendal vein
Deep dorsal vein:
Drains glans penis & corpora cavernosa penis
Divide into left & right branches which connect with
internal pudendal vein & enters the prostatic plexus.
Scrotal veins accompany the arteries
Veins emerging from the testis & Epididymis form

Epididymis
Esophagus

Stomach

Duodenum
Jejunum &
Ileum
Cecum
Appendix
Ascending
colon
Transverse
colon
Descending
& sigmoid
colon
Spleen
Pancreas
Liver
Bile duct
Gall bladder
& cystic
duct
Kidneys

Pampiniform venous plexus, a network of 8-12 veins lying

anterior to the ductus deferens & surrounding the testicular
artery in the spermatic cord.
The veins of each pampiniform plexus converge superiorly
forming right testicular vein which enters inferior vena
cava & a left testicular vein which enters the left renal
vein.
Same as testis.
The venous drainage from the submucosal veins of this part of
esophagus is both to
Portal venous system through left gastric vein
Systemic venous system through esophageal veins
entering the azygous vein
Veins of stomach parallel the arteries in position & course
Right & left gastric veins drain into hepatic portal vein
Short gastric veins & left gastroepiploic (gastro-omental)
veins drain into splenic vein which joins superior
mesenteric vein (SMV) to form hepatic portal vein
Right gastroepiploic (gastro-omental) vein empties into
SMV.
Prepyloric vein ascends over the pylorus to the right
gastric vein.
Superior pancreaticoduodenal vein drains into portal
vein
Inferior pancreaticoduodenal vein joins the SMV
Superior mesenteric vein (SMV)
Venous drainage from cecum flow through a tributary of
SMV, the ileocolic vein.
SMV (same as cecum)
SMV
SMV
From inferior mesenteric vein Splenic vein hepatic portal
vein.
Splenic vein
Splenic vein
Superior mesenteric vein (SMV)
Portal vein
Hepatic sinusoids drain into interlobular veins which join
to form sublobular veins which join to form hepatic veins
which drain into inferior vena cava (IVC)
From posterior superior pancreaticoduodenal vein to hepatic
portal vein.
From cystic veins to hepatic portal vein
Right & Left renal veins
Interlobular veins arcuate veins interlobar veins renal vein
IVC

Ureters
Suprarenal
glands
Urinary
bladder
Male
urethra

Female
urethra
Rectum

Anal canal
Ovaries

Uterine
tubes
Uterus
Vagina
Ductus
deferens
Prostate
gland

Renal veins
Gonadal (testicular/ovarian) veins.
Suprarenal veins
Right suprarenal vein IVC
Left suprarenal vein joins inferior phrenic vein drains
into Left renal vein.
Vesical venous plexus which drains into Internal iliac veins
Anterior urethra:
Dorsal vein of penis internal pudendal vein prostatic venous
plexus.
Posterior urethra:
Prostatic & vesical venous plexus internal iliac veins.
Venous plexus around urethra vesical venous plexus internal
pudendal vein
Superior rectal vein tributeries of this vein arise from
internal rectal venous plexus.
Middle rectal vein open into internal iliac veins.
Median sacral vein joins left common iliac vein
Internal rectal venous plexus
External rectal venous plexus
Anal veins
Veins drainig the ovary form a vine like pampiniform plexus
of veins. The plexus condenses into a single ovarian vein near
pelvic inlet.
Right ovarian vein drains into inferior vena cava
Left ovarian vein drains into left renal vein.
Tubal veins : drain into pampiniform venous plexus & uterine
venous plexus.
The veins form a plexus. Plexus drains through Uterine ,
ovarian & vaginal veins into internal iliac veins.
Vaginal venous plexus drains into internal iliac veins.
Vesical venous plexus which opens into internal iliac veins.
Veins form a rich plexus which communicates with vesical
plexus & with internal pudendal vein & drains into vesical &
internal iliac veins.

Reference: K.L.M & B.D chaurasia

NERVE SUPPLY OF ABDOMEN &

PELVIS
Anterolate
ral
abdominal
wall

Skin & muscles of anterolateral abdominal wall are supplied by:

Thoracoabdominal (T7-T11):
Continuation of lower (7th 11th ) intercostal nerves.
Supply: Muscles of anterolateral abdominal wall &
overlying skin.
Lateral cutaneous (thoracic) cutaneous branches ( 7th
9th):
Supply : Skin of right & left hypochondriac regions.
Subcostal (anterior ramus of T12):
Supply: Muscles of anterolateral abdominal wall &

Muscles of
Anterolate
ral
abdominal
wall
Penis

Scrotum

Testis

Epididymis
Esophagus

Stomach

overlying skin, superior to iliac crest & inferior to

umbilicus.
Iliohypogastric & Ilioinguinal nerves:
( terminal branches of anterior ramus of spinal nerve L1)
Ilihypogastric: Supply: Skin overlying iliac crest , upper
inguinal & hypogastric regions, internal oblique &
transverses abdominis muscles.
Ilioinguinal : Supply: Skin of lower inguinal region , mons
pubis, anterior scrotum or labium majus & adjacent medial
thigh, inferior most internal oblique & transverses
abdominis.
External oblique: Thoracoabdominal & subcostal nerve.
Internal oblique: Thoracoabdominal & first lumbar nerve
Tranversus abdominis: Thoracoabdominal & first lumbar
nerve.
Rectus abdominis: Thoracoabdominal nerves.
Sensory nerve supply : sensory nerve supply is derived from
Dorsal nerve of penis
Ilioinguinal nerve
Autonomic : Autonomic nerves are derived from Pelvic plexus
via prostatic plexus.
Sympathetic nerves are vasodilator
Parasympathetic nerves (S2,S3,S4) are vasodilator.
Autonomic fibers are distributed through pudendal nerve.
Muscles of Penis: supplied by perineal branch of pudendal
nerve.
The nerves of scrotum include
Branches of lumbar plexus to anterolateral surface.
Branches of sacral plexus to posterior & inferior surfaces.
Anterolateral surface: Genital branch of genitofemoral
nerve (L1 & L2).
Anterior surface: Anterior scrotal nerves (branches of
ilioinguinal nerve L1)
Posterior surface: Posterior scrotal nerves (branches of
perineal branch of pudendal nerve S2,S3,S4)
Posteroinferior surface: Perineal branches of posterior
cutaneous nerve of thigh S2,S3.
Dartos muscle: Genital branch of genitofemoral nerve.
The autonomic nerves of testis arise as testicular plexus of
nerves & contain:
Vagal parasympathetic & visceral afferent fibers.
Sympathetic fibers from T7 segment of spinal cord.
Testicular plexus of nerves
Esophagus is innervated by the esophageal plexus formed by:
Vagal trunks
Thoracic sympathetic trunks via greater splanchnic nerves
& peri-arterial plexus around left gastric & inferior phrenic
arteries.
Sympathetic nerve supply : From T6-T9 segments of spinal
cord passes to celiac plexus through greater splanchnic nerve &
is distributed through the plexus around gastric & gastro-

omental arteries.
Parasympathetic nerve supply: From
Anterior vagal trunk (derived mainly from left vagus
nerve):
Gives off: Hepatic, duodenal & anterior gastric branches.
Posterior vagal trunk ( derived mainly from right vagus
nerve):
Gives off: a celiac branch , posterior gastric branches &
branches to anterior & posterior surfaces of stomach.
Duodenum Sympathetic nerve supply: T9 & T10 segments of spinal
cord.
Parasympathetic nerve supply: Derived from vagus &
greater and lesser splanchnic nerves by the way of celiac &
superior mesenteric plexuses & reach the duodenum along its
arteries.
Jejunum &
(Reference from BD Chaurasia)
Ileum
Nerve supply is derived from sympathetic & parasympathetic
nerves
Sympathetic: T9-T11
Parasympathetic: from vagus nerve
(Reference from Keith.L.Moore)
The sympathetic fibers originate in the T8-T10
segments of spinal cord & reach the superior mesenteric
nerve plexus through sympathetic trunks & thoracic
abdominopelvic (greater,lesser & least) splanchnic nerves.
The parasympathetic fibers derived from posterior
vagal trunks.
Cecum
Sympathetic: originate in lower thoracic part of spinal cord.
Parasympathetic: derive from vagus nerve.
Branches from sympathetic & parasympathetic nerves form
the superior mesenteric plexus.
Appendix
Same as cecum
Ascending Sympathetic & parasympathetic (vagus) nerves from superior
colon
mesenteric plexus.
Transverse Superior mesenteric nerve plexus via peri-arterial plexuses of
colon
right & left colic arteries.
These nerves transmit sympathetic, parasympathetic (vagal) &
visceral afferent nerve fibers.
Descendin
g&
sigmoid
colon
Pancreas
Liver

Sympathetic: From lumbar part of sympathetic trunk via :

Lumbar splanchnic nerves
Superior mesenteric plexus
Peri-arterial plexus
Parasympathetic: From pelvic splanchnic nerves via:
Inferior hypogastric plexus & nerves.
Sympathetic: Splanchnic nerves through the plexus.
Parasympathetic: Vagus
Nerves of liver derived from Hepatic plexus ( derivative of
celiac plexus)
Which consists of
Sympathetic fibers from celiac plexus
Parasympathetic fibers from anterior & posterior vagal

trunks.
Nerves to gall bladder & custic duct from:
Celiac plexus sympathetic & visceral afferent fibers.
Vagus nerve parasympathetic fibers
Right phrenic nerve Somatic afferent fibers.
Renal nerve plexus which consists of
Sympathetic T10-L1 & parasympathetic fibers.
Ureters
Renal plexus
Abdominal aortic plexus
Superior hypogastric plexus
Suprarenal
Celiac plexus
glands
Abdominopelvic (greater, lesser & least splanchnic
nerves)
Diaphrag
Motor nerve supply: Phrenic nerves (ventral rami C3,C4,C5)
m
Sensory nerve supply:
Central part: Phrenic nerve
Peripheral part: lower 6 thoracic nerves
Muscles of Psoas major : Anterior rami of lumbar nerves L1, L2, L3.
posterior
Iliacus: Femoral nerve (L2-L4)
abdominal Quadratus lumborum: Anterior branches of T12 & L1-L4 nerves.
wall
Urinary
Urinary bladder is supplied by vesical plexus of nerves which
bladder
is made up of nerves derived from inferior hypogastric plexus.
Vesical plexus contains both sympathetic & parasympathetic
components, each of which contains motor(efferent) &
sensory(afferent) fibers.
Parasympathetic efferent fibers S3,S3,S4
Sympathetic efferent fibers T11-L2.
Somatic: pudendal nerve (S2,S3,S4)
Sensory nerves
[For detail see page#378 BD
Chaurasia]
Male
Nerves are derived from prostatic plexus ( one of the pelvic
urethra
plexus)
Parasympathetic nerves are from 2nd to 4th sacral segments.
Gall
bladder &
Cystic
duct
Kidneys

Female
urethra

Vesical plexus & pudendal nerve.

Explanation:
Parasympathetic preganglionic fibers from 2nd to 4th
sacral segments of spinal cord. Synapse in vesical venous
plexus. Post-ganglionic fibers reach smooth muscles.
Somatic fibers from S2-S4. Do not synapse in vesical
venous plexus.
Sensory fibers in pelvic splanchnic nerves reach to 2nd to
4th sacral segments of spinal cord.
Postganglionic sympathetic fibers arise from plexus
around vagina arteries.

Rectum

Nerve supply to rectum is derived from sympathetic &

parasympathetic systems.
Sympathetic: from lumbar spinal cord (L1-L2) conveyed

Anal canal

Ovaries &
uterine
tubes

Uterus

Vagina

Prostate
Gland

via:
Lumbar splanchnic nerve
Hypogastric/pelvic plexus
Peri-arterial plexus (of inferior mesenteric & superior
rectal arteries)
Parasympathetic: from S2-S4 passing via
Pelvic splanchnic nerves
Left & right inferior hypogastric plexus to the rectal
(pelvic) plexus.
Above pectinate line:
Sympathetic: Inferior hypogastric plexus
Parasympathetic: Pelvic splanchnic nerve S2,S3.
Below pectinate line:
Somatic: inferior rectal nerve (S2,S3,S4) branch of
pudendal nerve
External anal sphincter:
Inferior rectal nerve
Perineal branch of 4th sacral nerve
Ovarian plexus : Derived from renal, aortic &
hypogastric plexus. Contains both sympathetic &
parasympathetic nerve fibers.
Sympathetic: T10-T11 are afferent for pain as well as
efferent or vasomotor.
Parasympathetic: S2,S3,S4 are vasodilator.
Uterine plexus
Sympathetic & parasympathetic nerves through Inferior
hypogastric & ovarian plexus.
Sympathetic nerves are from T12 & L1.
Parasympathetic nerves are S2,S3,S4.
Lower 1/3rd : Supplied by pudendal nerve through inferior
rectal & posterior labial branches of perineal nerve.
Upper 2/3rd : Supplied by
Sympathetic L1,L2
Parasympathetic S2,S3,S4.
Nerves are derived from inferior hypogastric & uterovaginal
plexus.
Prostate is supplied by Prostatic plexus of nerves which is
derives from lower part of inferior hypogastric plexus.

Reference: K.L.M & B.D chaurasia

LYMPHATIC DRAINAGE OF ABDOMEN

& PELVIS
Anterolater
al
abdominal
wall

Lymphatic drainage of anterolateral abdominal wall follows the

following pattern.
Superficial Lymphatic vessels:
Superior to transumbilical plane: Drains into axillary
lymph nodes, however a few drain into parasternal lymph
nodes
Inferior to transumbilical plane: Drain into superficial
inguinal lymph nodes.
Deep Lymphatic vessels:

Penis
Testis &
Epididymus
Scrotum
Esophagus
Stomach

Duodenum

Jejunum &
Ileum

Cecum
Appendix
Ascending
colon
Transverse
colon
Descending
& sigmoid
colon
Spleen
Pancreas
Liver

Bile duct

Drain into external iliac

Common iliac
Right & left lumbar (caval & aortic) lymph
nodes.
Deep Inguinal lymph nodes glans penis
Superficial inguinal lymph nodes rest of penis
Right & left lumbar (caval/aortic) lymph nodes
Preaortic lymph nodes
Superficial inguinal lymph nodes
Left gastric lymph nodes ( Efferent lymphatic vessels from
these nodes drain mainly to celiac lymph nodes)
Stomach can be divided into 4 lymphatic territories:
Upper part of left 1/3rd pancreaticosplenic nodes
Right 2/3rd left gastric nodes
Lower part of left 1/3rd Right gastroepiploic nodes
Pyloric part pyloric lymph nodes
Anterior lymphatic vessels : Drain upward into
pancreaticoduodenal lymph nodes & into pyloric lymph
nodes
Posterior lymphatic vessels: Drain downward via
pancreaticoduodenal nodes to the superior mesenteric
lymph nodes
Efferent lymphatic vessels of all above lymph nodes drain into
celiac lymph nodes.
Lymph passes through 3 groups of lymph nodes:
Juxta-intestinal lymph nodes
Mesenteric lymph nodes
Superior central lymph nodes
Efferent lymphatic vessels from the mesenteric lymph nodes
drain into superior mesenteric lymph nodes.
Lymph passes from several mesenteric lymph nodes to ileocolic
lymph nodes , then to superior mesenteric lymph nodes.
Same as cecum in addition to appendicular nodes
Lymph passes from :
Epicolic & paracolicIleocolic & intermediate right colic
nodessuperior mesenteric lymph nodes.
Middle colic lymph nodesSuperior mesenteric lymph nodes
Intermediate colic lymph nodes
Inferior mesenteric lymph nodes
Lymph from left colic flexure may also drain to superior
mesenteric lymph nodes.
Pancreaticosplenic lymph nodesceliac lymph nodes
Pancreaticosplenic lymph nodes
Celiac lymph nodes
Superior mesenteric lymph nodes
Superficial lymphatics caval , hepatic, paracardial &
celiac lymph nodes.
Deep lymphatics inferior vena cava & hepatic lymph
nodes.
Cystic nodes celiac lymph nodes
Lymph node of omental foramen celiac lymph nodes
Hepatic lymph nodes celiac lymph nodes

Gall
bladder &
cystic duct
Kidneys
Ureters

Suprarenal
glands
Urinary
bladder
Male
urethra
Female
urethra
Rectum
Anal canal
Ovaries &
uterine
tubes
Uterus

Vagina
Prostate
gland

Hepatic lymph nodes celiac lymph nodes

Cystic lymph nodes celiac lymph nodes
Right

& left lumbar ( caval & aortic ) lymph nodes

Superior part Lumbar lymph nodes
Middle part common iliac lymph nodes
Inferior part common, external or internal iliac lymph
nodes.
Lateral aortic ( lumbar) lymph nodes

External iliac nodes

Internal iliac/lateral aortic nodes
Prostatic urethra internal iliac lymph nodes
Membranous urethra internal iliac lymph nodes
Anterior urethra deep inguinal lymph nodes.
Internal iliac lymph nodes
External iliac lymph nodes
Upper half of rectum : Inferior mesenteric nodes after
passing through pararectal & sigmoid nodes
Lower half of rectum: Internal iliac nodes
Above pectinate line: Internal iliac lymph nodes
common iliac & lumbar lymph nodes
Below pectinate line : Superficial inguinal lymph nodes.
Lateral aortic & preaortic lymph nodes.
3 lymphatic territories:
Upper lymphatics: Drain into aortic & superficial
inguinal lymph nodes.
Middle lymphatics: Drain into external iliac lymph
nodes.
Lower lymphatics: External iliac, internal iliac & sacral
nodes.
Upper 1/3rd : External iliac nodes
Middle 1/3rd : Internal iliac nodes
Lower 1/3rd : Medial group of superficial inguinal lymph nodes.
Internal iliac lymph nodes.
External iliac lymph nodes.
Sacral lymph nodes.

Reference: K.L.M & B.D chaurasia