*
Dr. Sama-ul-Haque
Dr. Rania Gabr
Dr Safaa Ahmed
*
 Describe the origin, termination, course and
branches of the internal iliac artery.
 Discuss the origin, site, relations, branches & their
final distribution of the sacral plexus.
 Discuss the anatomy of the autonomic supply of the
pelvic organs.
*
 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 division supplies:
1- Posterior abdominal wall.
2- Posterior pelvic wall.
3- Gluteal region.
The Anterior division supplies:
1. Pelvic viscera (Except Ovary).
2. Perineum.
3.Gluteal region.
4.Adductor (medial)region of the thigh.
5.The fetus (through the umbilical arteries)
*

1- Umbilical artery

Gives the superior vesical artery

The distal fibrous part of this
artery becomes the “Medial
Umbilical Ligament”.

2- Obturator artery: pelvic musc. , ms of
med comp of thigh, nutrient arts.

3- 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.
4- Middle rectal artery: supplies: Semin.
vesicle, prostate (vagina), inf part of the
rectum
5- 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.
*
6- Inferior gluteal artery: pelvic
diaphragm, piriformis, QF, upper
hamstrings,Glut. Max. and Sciatic nerve
7- Uterine artery (Female)

Crosses the ureter superiorly

Ascends in the layers of broad
ligament of uterus

Ends by anastomoses with ovarian
artery
8- Vaginal artery (Female): divides into:
1- vaginal: to vagina
2-inferior vesical : to urinary bladder
*
Anterior
division



*
1- Iliolumbar artery: ps. Major,
quadr. Lumb, iliacus,and cauda
equina
2- Lateral sacral artery:
piriformis, erector spinae and
skin over, str. In sacral canal
3-Superior gluteal artery:
piriformis, gluteii, tensor fascia
lata
*
Posterior
division
*
*The pelvis is drained:
• 1- Mainly by the
internal iliac veins and
their tributaries.
• 2- Superior rectal veins
• 3- Median sacral vein.
• 4- Gonadal veins.
• 5- Internal vertebral
venous plexus
*
*(A) Somatic:
Sacral plexus
- From 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.
2. 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 inferiorly
in front of the coccyx and form
a single ganglion (Ganglion
Impar).
(b) Superior & Inferior
Hypogastric plexuses.


*
Lies on the posterior pelvic wall in
front of Piriformis muscle.
Formed from:

The anterior rami of 4th & 5th
lumbar nerves

The anterior rami of 1st, 2nd, 3rd
& 4th sacral nerves

4th lumbar nerve joins the 5th
lumbar nerve to form
Lumbosacral Trunk
*The pudendal nerve
(S2 to 4) supplies most
of the perineum.
*It contains motor,
sensory (pain and
reflex), and
postganglionic
sympathetic fibers.
* It can be "blocked"
medial to the ischial
tuberosity, e.g., during
labor.
Pelvic Part of Autonomic Nervous System
1- The pelvic splanchnic
nerves:
*The pelvic splanchnic
nerves (S2 to 4) contain
parasympathetic
preganglionic and sensory
fibers.
*They help to form the
inferior hypogastric
plexus.
The inferior hypogastric plexuses
contain:
*(1) Postganglionic sympathetic
fibers;
*(2) Preganglionic
parasympathetic fibers, which
supply the descending and sigmoid
colon and the pelvic viscera.
* (3) Sensory fibers including :
1- Pain fibers (many of which travel
in the lumbar splanchnic nerves)
2- Reflex fibers from the bladder
(which ascend in the pelvic
splanchnic nerves).
*They give origin to the
following plexuses,
which innervate the
pelvic viscera:
1-the rectal plexus;
2-the uterovaginal
plexus;
3-the prostatic plexus;
and
4-the vesical plexus.
2- Sympathetic fibers
Reach the pelvis by downward
continuations of the 1- sympathetic
trunks and of the 2- aortic plexus.
*The aortic plexus is continued as the
superior hypogastric plexus which
divides in front of the sacrum into
right and left hypogastric nerves.
*The hypogastric nerve descends &
unites with the pelvic splanchnic
nerves to form the right and left
inferior hypogastric plexuses ,
which give branches to the pelvic
viscera (e.g., the rectum, bladder, and
*
*