Lymphatic vessels and pelvic nodes

Lymph nodes are located in the pelvic cavity and on its walls, into which lymphatic vessels flow from adjacent organs, as well as lymphatic vessels of the lower extremities. Depending on their position, the pelvic lymph nodes are divided into visceral (internal) and parietal (parietal).

Visceral lymph nodes (nodi lymphatici viscerales) are adjacent to the internal organs located in the pelvic cavity. Single lymph nodes are found near the bladder - paravesical (nodi lymphatici paravesiculares), between the layers of the broad ligament of the uterus - parauterine (nodi lymphatici parauterine), and slightly lower - paravaginal (nodi lymphatici paravaginales). On the lateral surfaces of the rectum, near its lower sections, are pararectal (anorectal) lymph nodes (nodi lymphatici pararectales, s.anorectales), the number of which can be from 1 to 10. Efferent lymphatic vessels from the visceral lymph nodes are directed to the iliac nodes, mainly the common ones, and to the subaortic nodes (under the bifurcation of the aorta). Some lymphatic vessels, including those from the ovaries, flow upward to the lumbar lymph nodes.

Parietal lymph nodes (nodi lymphatici parietales) are adjacent to the walls of the pelvis, located near large blood vessels. On each side wall of the small pelvis, near the internal iliac artery and vein, there are 4-8 internal iliac lymph nodes (nodi lymphatici iliaci interni).

Next to the superior and inferior gluteal arteries are the gluteal lymph nodes (nodi lymphatici gluteales), to which lymphatic vessels from the tissues of the back of the thigh and the gluteal region, as well as from the adjacent walls of the small pelvis, are directed through the supra- and infra-piriform openings. Along the obturator vessels and nerves (in about a third of cases), there are obturator (usually one) lymph nodes (nodi lymphatici obturatorii).

On the anterior surface of the sacrum, medially from the anterior sacral openings, there are 2-3 sacral lymph nodes (nodi lymphatici sacrales). They are regional nodes not only for the pelvic walls, but also for the rectum, since they are adjacent to its posterior surface. From the named parietal lymph nodes of the small pelvis, the efferent lymphatic vessels are directed to the external and common iliac lymph nodes, located near the large iliac blood vessels. The external lymph nodes (nodi lymphatici iliaci externi, 2-12 in total) are located near the external iliac arteries and veins, forming medial, lateral and intermediate (in the groove between the vessels) chains. The lower of these nodes lies directly behind the inguinal ligament, covering the vascular lacuna and the femoral ring from above.

The efferent lymphatic vessels of the internal and external iliac lymph nodes are directed to the common iliac nodes (nodi lymphatici iliaci communes), which in the amount of 2-10 lie on the lateral wall of the pelvis next to the common iliac artery and vein and also form lateral, intermediate and medial chains. The medial chain of common iliac lymph nodes ends with 1-2 nodes common to the right and left sides. These nodes are located directly at the beginning of the common iliac arteries from the abdominal part of the aorta - under the bifurcation of the aorta and are called subaortic lymph nodes (nodi lymphatici subaortici).

The efferent lymphatic vessels of the common iliac and subaortic nodes are directed to the lumbar lymph nodes, which lie near the abdominal part of the aorta and inferior vena cava.

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