Topographic Anatomy

of the Pelvis
1. Pelvis – boundaries, landmarks and regions
2. Peritoneal pelvic compartment
3. Subperitoneal pelvic compartment
4. Subcutaneous pelvic compartment,
the perineum
5. Peritoneal formations and spaces –
topographical relations
 Pelvis – borders and compartments
▪ cranial border – the pelvic inlet,
Pelvis
linea terminalis:
✓ the promontorium
✓ linea arcuata, pecten ossis pubis
✓ pubic symphisis
▪ caudal border – the soft tissues of the perineum
▪ lateral border – the walls of the lesser pelvis
▪ compartments:
✓ peritonel
✓ subperitoneal
✓ subcutaneous = perineum
 Pelvis – borders and compartments
▪ cranial border – the pelvic inlet,
Pelvis
linea terminalis:
✓ the promontorium
✓ linea arcuata, pecten ossis pubis
✓ pubic symphisis
▪ caudal border – the soft tissues of the perineum
▪ lateral border – the walls of the lesser pelvis
▪ compartments:
✓ peritonel
✓ subperitoneal
✓ subcutaneous = perineum
 Important
landmarks
External palpation landmarks
▪ Bone points and lines:
✓ spina iliaca anterior superior
✓ spina iliaca posterior superior
✓ crista iliaca
✓ symphysis pubica
✓ ramus superior ossis pubis
✓ tuberculum pubicum
✓ crista sacralis mediana
✓ apex ossis coccygis
✓ tuber ischiadicum
✓ spina ischiadica
✓ arcus pubis
✓ promontorium ossis sacri (in females)
 Peritoneal pelvic compartment,
Cavitas pelvis
cavum pelvis peritoneale
peritonealis ▪ most inferior portion of the peritoneal cavity
▪ pelvic viscera: the rectum, urinary bladder,
the uterus, uterine tubes, ovary (in females)
▪ in males: ▪ in females:
✓ plica vesicalis transversa ✓ vesico-uterine excavation
✓ recto-vesical excavation (pouch of Meiring)
(pouch of Ben) ✓ recto-uterine excavation
✓ plicae rectovesicales (Douglas pouch or space) 
plica rectouterina
(lig. sacrouterinum)
 Peritoneum parietale anterius
Urinary bladder
puncture ✓ plica umbilicalis mediana – urachus
 fossa supravesicalis
✓ plica umbilicalis medialis – chorda a. umbilicalis
 fossa inguinalis medialis: anulus inguinalis
✓ plica umbilicalis lateralis – a. et v. epigastrica inferior sup.
✓ plica vesicalis transversa  fossa inguinalis lateralis: anulus inguinalis
prof.
 Subperitoneal pelvic compartment,
Spatium
cavum pelvis subperitoneale
retroperitoneale (extraperitoneal pelvic space)
▪ pelveoperitoneum parietale
▪ fascia pelvis parietalis  arcus tendineus fasciae pelvis
▪ m. levator ani } parietal connective tissue spaces
▪ fascia pelvis visceralis
 topography
content
The prevesical space,
Anders Retzius spatium prevesicale (retropubicum),
(1796-1860) cavum Retziusi
▪ boundaries:
✓ anteriorly:
➢ the inferior part of the abdominal wall
➢ symphisis pubica
➢ os pubis
✓ posteriorly:
➢ the anterior aspect
of the urinary bladder
➢ the prostate (in men)
✓ laterally:
➢ lig. pubovesicale
✓ floor:
➢ the urogenital diaphragm
▪ content:
✓ plexus venosus vesicalis
✓ plexus venosus prostaticus
✓ a. vesicalis superior et inferior
✓ loose connective tissue:
➢ lig. pubovesicale
➢ lig. puboprostaticum (у мъже)
▪ spatium paravesicale  paracystium
topography
content
The retrovesical space,
Spatium spatium retrovesicale (prerectale)
retrovesicale
▪ boundaries:
✓ posterior wall of the urinary bladder
✓ fibrous septum
(septum prerectale):
➢ peritoneum – above
➢ perineum – below
▪ content in men:
✓ plexus venosus prostaticus
✓ the prostate gland
✓ ductus defferens – pelvic part
✓ seminal vesicles
✓ ureters – pelvic part
▪ content in women:
✓ vagina
✓ septum pre- et retrovaginale
 topography
content
The retrorectal (presacral) space,
Spatium presacrale
spatium retrorectale (presacrale)
▪ boundaries:
✓ posterior wall of the rectum
✓ the sacrum
▪ content:
✓ loose and adipose tissue
✓ a. rectalis superior et media
✓ aa. sacrales laterales
✓ plexus venosus sacralis
✓ plexus hypogastricus inferior
✓ pars pelvina trunci sympathici
✓ pelvic lymph nodes
▪ communication with:
✓ retroperitoneal abdominal
compartment
▪ paraproctium
 topography
content
The lateral space,
Spatium paravesicale spatium laterale
▪ spatium paravesicale (paracysticum)
▪ spatium pararectale (paraproctium)
▪ location – laterally and between:
✓ fascia pelvis parietalis
✓ fascia pelvis visceralis
✓ fascia diaphragmatis pelvis
superior – below
▪ communication with:
✓ the retroperitoneal space upwards
✓ the gluteal region  foramen
suprapiriforme et infrapiriforme
✓ the thigh  canalis obturatorius
▪ content:
✓ plexus sacralis
✓ plexus hypogastricus inferior
✓ branches of a. iliaca interna
✓ venous plexuses
topography
content
The parametrial space,
Parametrium parametrium
▪ Portions and location:
✓ the lateral parametrium
 between the layers of
lig. latum uteri (mesovarium,
mesosalpinx, mesometrium)
✓ the precervical and retrocervical parametrium
 laterally to the uterine cervix
▪ Content:
✓ plexus venosus uterinus et
vaginalis
✓ plexus
uterovaginalis
✓ a. uterina
✓ the ureter
✓ lymph nodes
 Spatial relationships
of the pelvic viscera
▪ the urinary bladder, vesica urinaria
▪ the rectum, rectum
in men:
▪ the prostate, prostata
▪ the seminal vesicles,
vesiculae seminales
▪ the pelvic part of the ductus deferens,
ductus deferens
in women:
▪ the uterus, uterus
▪ the uterine tube, tuba uterina
▪ the ovary, ovarium
▪ the vagina, vagina
 Spatial relationships of the
Venous plexuses blood and nerve structures
▪ a. et v. iliaca interna
▪ plexus hypogastricus superior
(presacralis)
▪ plexus hypogastricus inferior
(pelvicus)
▪ plexus lumbosacralis
▪ plexus venosus rectalis
▪ plexus venosus vesicalis
▪ venous plexuses in men:
✓ plexus deferentialis
✓ plexus prostaticus
▪ venous plexuses in women:
✓ plexus uterovaginalis
▪ pelvic lymph nodes:
✓ nodi lymphatici iliaci externi
✓ nodi lymphatici iliaci interni
✓ nodi lymphatici sacrales
✓ nodi lymphatici
ischiorectales
✓ nodi lymphatici
diaphragmatis pelvis
▪ pars pelvina trunci sympathici
topography
content
Subcutaneous pelvic compartment,
Regio cavum pelvis subcutaneum
perinealis
▪ The perineum, perineum
▪ the pelvic floor boundaries:
✓ anteriorly – inferior symphysis margin
✓ laterally – os pubis, os ischii,
tuber ischiadicum,
lig. sacrotuberale
✓ posteriorly – apex ossis coccygis
▪ regio perinealis:
✓ regio analis (trigonum anale)
✓ regio urogenitalis (trigonum urogenitale)
▪ content – muscles and fascias  diaphragma pelvis
diaphragma urogenitalis
 Regio analis
Regio analis ▪ the rectum, rectum
▪ the anal verge, anus:
✓ m. sphincter ani externus
✓ lig. anococcygeum
✓ nodi lymphatici rectales superiores 
nodi lymphatici mesenterici inferiores

✓ nodi lymphatici iliaci interni

✓ nodi lymphatici inguinales superficiales
 Regio analis
Regio analis ▪ the rectum, rectum
▪ the anal verge, anus:
✓ m. sphincter ani externus
✓ lig. anococcygeum
✓ nodi lymphatici rectales superiores 
nodi lymphatici mesenterici inferiores

✓ nodi lymphatici iliaci interni

✓ nodi lymphatici inguinales superficiales
 topography
content
Fossa ischioanalis
Fossa ischioanalis (ischiorectalis)
▪ borders:
✓ laterally – tuber ischiadicum, fascia m. obturatorii internil
✓ medially and superiorly – fascia diaphragmatis pelvis inferior
▪ content:
✓ adipose tissue, corpus adiposum – abscesses
✓ neurovascular bundle –
a. et v. pudenda interna, n. pudendus
 topography
content
Pudendal canal, Alcock’s canal
▪ a sheath derived from the fascia of the obturator internus
Alcock,
Benjamin Thomas
muscle, 0,3-0,5 cm in length
(1801-1855-?) ▪ content – regional neurovascular bundle:
✓ a. pudenda interna – a. rectalis inf., a. perinealis, aa. scrotales
(labiales) postt., a. bulbi penis (vestibuli), a. profunda penis
(clitoridis), a. dorsalis penis (clitoridis)
✓ n. pudendus – nn. rectales inff., nn. perineales, nn. scrotales
(labiales) postt., n. dorsalis penis (clitoridis)
Clinical significance
▪ saddle and perineal anesthesia
▪ landmark – the ischial tuberosity

▪ pudendal nerve entrapment (Alcock canal syndrome) –

a chronic neuropathic pain caused by pudendal nerve compression
▪ landmark – the sacrospinous ligament
 topography
surface anatomy
The pelvic floor: diaphragma pelvis
▪ Surface anatomy:
✓ skin
✓ subcutaneous fat tissue –
a., v. et nn. perineales
✓ m. sphincter ani externus,
m. levator ani, m. coccygeus
✓ fascia diaphragmatis pelvis
inferior
✓ m. transversus perinei prof.
✓ fascia diaphragmatis pelvis
superior
✓ loose connective tissue 
hiatus urogenitalis
 topography
surface anatomy
Trigonum urogenitale
▪ spatium perinei superficiale:
Diaphragma ✓ fascia perinei superficialis
urogenitale  fascia penis (clitoridis)
✓ centrum tendineum perinei
(corpus perinealis)
✓ m. ischiocavernosus,
m. bulbocavernosus
(m. bulbospongiosus)
✓ m. transversus perinei superficialis
✓ fascia diaphragmatis urogenitalis inferior
▪ spatium perinei profundum
(diaphragma urogenitale):
✓ m. transversus perinei profundus,
m. sphincter urethrae externus
✓ fascia diaphragmatis urogenitalis superior
Elvis Pelvis

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