BLOOD SUPPLY, INNERVATION AND

LYMPAHATIC DRAINAGE OF THE PELVIS

• Internal Iliac Artery
Common iliac artery divides in front of the
sacroiliac joint into external and internal iliac
arteries. The Internal Iliac Artery passes down
into the pelvis. At the upper margin of greater
sciatic foramen it divides into anterior and
posterior divisions.
 The Posterior and Anterior division
The Posterior division supplies the:
1. Posterior abdominal wall.
2. Posterior pelvic wall.
3. Gluteal region.
The Anterior division supplies the:
4. Pelvic viscera (Except Ovary)
5. Perineum.
6. Gluteal region.
7. Adductor (medial)region of the thigh.
8. The fetus (through the umbilical arteries)
Branches of the Anterior division of Internal
Iliac Artery
• Umbilical artery gives the superior vesical
artery, the distal fibrous part of this artery
becomes the Medial Umbilical Ligament.
• Obturator artery: pelvic muscle and medial
compartment of thigh.
• Inferior vesical artery (Male) It supplies the
prostate, inferior part of the bladder and the
seminal vesicles. It gives the artery to the Vas
Deferens.
 Contd
•  Middle rectal artery: supplies the Seminal
vesicle, prostate (vagina), inferior part of the
rectum.
• Internal pudendal artery leaves pelvis through
greater sciatic foramen, enters perineum by
passing through lesser sciatic foramen, enters
into pudendal canal with pudendal nerve.
Supplies anal canal musculature, skin &
muscles of perineum.
 Contd
• Inferior gluteal artery: pelvic diaphragm,
piriformis, QF, upper hamstrings, glut. Max. and
Sciatic nerve.
• Uterine artery (Female) crosses the ureter
superiorly, ascends in the layers of broad
ligament of uterus, ends by anastomoses with
ovarian artery.
• Vaginal artery (Female): divides into vaginal and
inferior vesical to urinary bladder
 Visceral Branches (in Female)
Vaginal artery: Replaces the inferior vesical
artery.Uterine artery:.Crosses the Ureter
superiorly and supplies the uterus & uterine
tubes.(B) Ovarian artery:Arises from the
abdominal aorta.
 Branches of Posterior division of Internal
Iliac Artery
•
1- Iliolumbar artery: ps. Major, quadr. Lumb,
iliacus,and cauda equina2- Lateral sacral
artery: piriformis, erector spinae and skin
over, str. In sacral canal3-Superior gluteal
artery: piriformis, gluteii, tensor fascia lata
 Venous Drainage The pelvis is drained:

• 1- Mainly by the internal iliac veins and their

tributaries.2- Superior rectal veins3- Median
sacral vein.4- Gonadal veins.5- Internal
vertebral venous plexus
 Nerve Supply of pelvis (A) Somatic:

•
Sacral plexusFrom Ventral rami of a part of L4
& whole L5 (lumbosacral trunk) + S1,2,3 and
most of S4.It gives Pudendal nerve to
perineum(B) Autonomic:1. Pelvic splanchnic
nerves (From S 2 , 3 & 4)They are the
Preganglionic parasympathetic nerves to
pelvic viscera & hindgut.
 Sympathetic: It is formed of:
•
(a) Pelvic part of sympathetic trunks:They are
the continuation of the abdominal trunks.They
Descend in front of the ala of the sacrum
&terminate inferiorlyin front of the coccyx and
form a single ganglion (Ganglion Impar).(b)
Superior & InferiorHypogastric plexuses.2.
Sympathetic:
• Sacral PlexusLies on the posterior pelvic wall
in front of Piriformis muscle.Formed from:The
anterior rami of 4th & 5th lumbar nervesThe
anterior rami of 1st, 2nd, 3rd & 4th sacral
nerves4th lumbar nerve joins the 5th lumbar
nerve to form Lumbosacral Trunk
• Autonomic innervation of the pelvic cavity is
via four routes:
1- the sacral sympathetic trunks,2- periarterial
plexuses,3- hypogastric plexuses: sup and inf,
and4- pelvic splanchnic nerves.
• he prevertebral plexus enters the pelvis as two
hypogastric nerves, one on each side, that cross
the pelvic inlet medially to the internal iliac
vessels.The hypogastric nerves are formed by the
separation of the fibers in the superior
hypogastric plexus, into right and left bundles.The
superior hypogastric plexus is situated anterior to
vertebra L5 between the promontory of the
sacrum and the bifurcation of the aorta.
• When the hypogastric nerves are joined by pelvic
splanchnic nerves carrying preganglionic
parasympathetic fibers from S2 to S4, the pelvic
plexuses (inferior hypogastric plexuses) are formed .The
inferior hypogastric plexuses, one on each side, course
in an inferior direction around the pelvic walls, medially
to major vessels and somatic nerves.They give origin to
the following subsidiary plexuses, which innervate the
pelvic viscera:1-the rectal plexus;2-the uterovaginal
plexus;3-the prostatic plexus; and4-the vesical plexus.