Pelvic Cavity

Prof. Julien GASHEGU

 The Pelvis
The pelvis is divided into two regions:

The false pelvis (greater pelvis)→ part of the abdomen .

The true pelvis (lesser pelvis) → has an inlet and an

outlet.

The pelvic cavity enclosed by the true pelvis consists of

the pelvic inlet, walls, and floor.
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 Bones of the pelvis
The bony pelvis is composed by:
1. 2 hip bones: described in detail in Gross
Anatomy I module.
- Students are advised to recall that gained
knowledge
2. sacrum and coccyx : same as above
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 Joints and ligaments of the pelvis
Joints of pelvis include:
a. symphysis pubis between the 2 pubic bones
b. sacro-iliac joints: between the auricular surfaces of
sacrum and ilium + syndesmose between sacral
tuberosity and iliac tuberosity
Main ligaments of the pelvis are:
a. sacrotuberous ligaments
b. sacrospinous ligaments
c. inguinal ligament
* The 2 ligaments define with the posterior border of hip
bone
- greater sciatic foramen and lesser sciatic foramen
* The inguinal ligament define with the anterior border of hip
bone the subinguinal space
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 Functions of the pelvis girdle

◼ Protect pelvic viscera

◼ Support weight of body and transmit it to lower
limbs
◼ Facilitate the walking movement by swinging
side to side during walk
◼ Provide attachment to muscles
◼ In female, provide bony support of birth canal
◼ Anchors the roots of the external genitalia
 The pelvic inlet

◼ Heart shaped and completely ringed by bone.

◼ Posteriorly bordered by the sacral promontory

and the alae (wings) of the sacrum

◼ Laterally, a prominent rim on the pelvic bone

continues the boundary of the inlet forward to
the pubic symphysis.
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 The Pelvic outlet
◼ The diamond-shaped
◼ Formed by both bone and ligaments.
◼ Limited anteriorly by the pubic symphysis.
◼ On each side, the pubic arch (the ischiopubic ramus)
and ischial tuberosity → margin of the anterior
half
◼ The sacrotuberous ligament continues this margin
posteriorly from the ischial tuberosity to the coccyx and
sacrum.
The pelvic diameters
 The pelvic walls and floor
◼ Bones,
◼ sacrum,
◼ coccyx,

◼ inferior half of the pelvic bones

◼ Muscles
◼ obturator internus
◼ piriformis muscles

◼ Ligaments converting the greater and lesser

sciatic notches into foraminae.
◼ sacrospinous ligament
◼ sacrotuberous ligament.
 Antero-inferior pelvic wall
The antero-inferior pelvic wall is formed by
bones only:
- bodies of pubic bones
- rami of pubic bones
- pubic symphysis
It support the urinary bladder
 Lateral pelvic walls
* the lateral pelvic walls are formed by the
right and left hip bones
* each hip bone includes the obturator
foramen that is closed by the obturator
membrane
* the obturator internus muscle is the muscle
of lateral wall and is covered by the
obturator fascia
* the obturator fascia is thickened centrally
to form the tendinous arch that provides
attachment to pelvic diaphragm
 Posterio-lateral wall and Roof
* the posterio-superior wall is formed by:
- sacrum and coccyx
- sacroiliac, sacrotuberous and sacrospinous
ligaments
- piriformis muscles
 The pelvic floor
◼ Formed by the pelvic diaphragm
◼ The attachment of the pelvic diaphragm to the
tendinous arch divides the obturator internus muscles
into a superior or pelvic part and an inferior or
perineal part
◼ The pelvic diaphragm consists of the coccygeus and
levator ani muscles and fasciae
◼ Coccygeus muscles arise on lateral side of the
inferior sacrum and coccyx and attach on the
sacrospinous ligaments
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 The pelvic floor
◼ Levator ani muscles is larger and most important
part of the pelvic floor. It stretches between anterior,
lateral and posterior walls of pelvis.
◼ Levator ani muscles limit an anterior gap: the urogenital
hiatus for passage of the urethra and in female the
vagina
◼ Levator ani muscle consists of 3 parts:

1. puborectalis: thicker, narrower, medial part of

levator ani. It forms a U-shaped muscular ring that
pass posterior to the anorectal junction, bounding the
urogenital hiatus. It plays a role in fecal continence
 The pelvic floor
◼ Levator ani muscle consists of 3 parts:
2. pubococcygeus: wider and thinner intermediate part
of the levator ani. It arises for the body of pubis and
tendinous arch and attaches on the coccyx;
◼ Shorter muscular slips of the pubococcgeus extend middle to
attach on midline stuctures forming pubovaginalis,
puboprostaticus, puboperinealis, puboanalis muscles
◼ 3. iliococcygeus: posterolateral part on the levator ani. It
arises from the tendinous arch and ischial tuberosity to attach
on the coccyx
◼ The pelvic diaphragm supports abdominopelvic viscera and
plays a role in urinary and fecal continence
 Pelvic cavity
◼ The peritoneum drapes over the superior aspects of
the pelvic viscera.
◼ The pelvic viscera located in the midline of the pelvic
cavity.
◼ The bladder is anterior and the rectum is posterior. In
women, the uterus between the bladder and rectum.
◼ The reflexion of peritoneum of pelvic viscera
explain the pelvic fossa or pouches: supra-vesical
fossa, recto-vesical pouch, vesico-uterine pouch,
rectouterine pouch = cul-de-sac of Douglas
◼ Vessels and nerves, lie deep to the peritoneum in
association with the pelvic walls
 Pelvic fasciae
◼ The pelvic fascia is connective tissue that occupies space
between the peritoneum and muscular pelvic walls and floor.
◼ Pelvic fascia consists of membranous pelvic fascia and
endopelvic fascia.
◼ Membranous pelvic fascia consists of visceral pelvic fascia that
covers pelvic viscera (adventitia) and parietal pelvic fascia
covering muscles of pelvic walls and floor. The parietal fascia
is thicker where pelvic viscera enter the floor to form
tendinous arch of pelvis
◼ Endopelvic fascia is the term given to the loose connective tissue
between parietal and visceral pelvic fascia.
◼ The loose tissue is site of potential space: retro-pubic and
retro-rectal spaces
 Pelvic fasciae: hypogastric sheath
The endopelvic fascia is condensed into hypogastric sheath for
passage of vessels and nerve and fascial ligaments which act as
supports for pelvic viscera.
These ligaments include the:
◼Cardinal (Mackenrodt’s) ligaments: pass laterally from the
cervix and upper vagina to the pelvic side walls.
◼Utero-sacral ligaments: pass backwards from the cervix and
vaginal fornices to the fascia overlying the sacro-iliac joints.
◼Pubocervical ligaments: extend anteriorly from the cardinal
ligaments to the pubis (puboprostatic in the male).
◼Pubovesical ligaments: from the back of the symphysis
pubis to the bladder neck
 PELVIC NERVES
◼ Somatic nerves from sacral and coccygeal plexuses:
see Gross Anatomy I module
◼ Pelvic autonomous nerves have 4 routes:
◼ 1. sacral sympathetic ganglia and trunks: each has 4
sacral ganglia and the 2 end by ganglion impar. They
send branches to the inferior pelvic plexus
◼ 2. peri-arterial plexuses: sympathetic fibers around
arteries in the pelvis
◼ 3. hypogastric plexuses: superior and inferior pelvic
plexuses
 PELVIC NERVES
◼ 3. hypogastric plexuses: superior and inferior pelvic plexuses
- the superior hypogastric plexus (sympathetic) gives the right
and left hypogastric nerves that contribute to form the inferior
hypogastric plexus
- the inferior hypogastric plexuses (sympathetic and
parasympathetic)
◼ 4. pelvic splanchnic nerves: arise from the anterior rami of S2-
S4 and contain parasympathetic fibers that contribute to form
the inferior hypogastric plexuses
◼ Around viscera there are pelvic plexuses from the inferior
hypogastric plexuses
 Pelvic Blood vessels
Arterial blood supply
◼Internal Iliac artery has 2 divisions

•I. posterior division that gives rise to 3 branches:

- iliolumbar artery ascends to give an iliac branch and a
lumbar branch
- lateral sacral artery supplies sacral meninges and
anterior sacral rami
- superior gluteal artery, the largest branch of the
posterior division that passes in the greater sciatic
foreman to supply the gluteal region
•2. anterior division:
 Pelvic Blood vessels
◼Internal Iliac artery has 2 divisions:
•II. anterior division gives branches that are mainly visceral:
1. umbilical artery: its distal part is occluded and become the medial
inguinal ligament, its proximal part is the superior vesical artery
2. obturator artery
3. Inferior vesical artery in male is replaced by Vaginal artery in female
4. Uterine artery in female
5. Middle rectal artery
6. Internal pudendal artery
7. inferior gluteal artery
◼Median sacral artery from abdominal aorta
◼Ovarian or testicular arteries from abdominal aorta
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 The Pelvic veins
◼ Pelvic veins follow the course of all branches of
the internal iliac artery except for the umbilical
artery, its branch the superior vesical artery and
the iliolumbar artery.
◼ On each side, the veins drain into internal iliac
veins, which leave the pelvic cavity to join
common iliac veins.
 Lymphatics
◼ Lymph nodes distributed along the internal iliac
and external iliac arteries and their associated
branches →nodes associated with the common
iliac arteries → nodes associated with the lateral
surfaces of the abdominal aorta → the lumbar
trunks →the thoracic duct