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Small pelvis
Last reviewed: 07.07.2025
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The pelvic cavity is lined with peritoneum, which covers all internal genital organs except the ovaries. The uterus is located in the center of the pelvis, in front of it is the urinary bladder, behind it is the rectum.
Between the uterus and the urinary bladder a depression is formed - the vesicouterine space (excavatio vesico-uterina), in which the filling urinary bladder is indicated as a spherical bulge.
The recto-uterine space (Douglas' pouch) (excavatio recto-uterina Douglasi) is deeper, and the rectum enters into it in the form of a short narrow tube, descending down the sacral fossa.
From the bottom of the uterus, above and behind the place of departure of the round ligament, the fallopian tubes (tubae uterinae) extend, located in the upper part of the broad ligament (lig. iatum) between its leaves. When departing from the uterus, the tube is thin, then gradually widens and ends in a funnel with an opening up to 0.5 - 1.0 cm in diameter, surrounded by fimbriae. The fimbriae approach the ovary and seem to embrace it. The fallopian tubes are mobile due to the mesentery (mesosalpinx), consisting of a duplication of the peritoneum, connected to the broad ligament.
The ovaries (ovaria) are located on the lateral walls of the pelvis in a special depression of the parietal peritoneum behind the broad ligament of the uterus, on the sides and behind it. By means of their own ligaments (lig. ovarii proprium) they are attached on one side to the angle of the uterus, on the other - with the help of the infundibulopelvic ligament (lig. infundibulo-pelvicum. s. lig. suspensorium ovarii) to the lateral wall of the pelvis. Between the sheets of the broad ligament lies only a small part of the ovary. It has a short mesentery (mesovarium), which is a duplication of the peritoneum, embracing the edge of the ovary in the form of a border. This is the so-called gate of the ovary (hilus ovarii), where the vessels and nerves pass.
The ovary and fallopian tube are closely adjacent to the ureter, which passes along the medial and posterior sides of the ovarian fossa (fossa ovarica) parallel to and on the inner side of the infundibulopelvic ligament, the abdominal end of the tube is separated from it only by a fold of the peritoneum.
Under the peritoneum covering the pelvic organs are located the tissue, ligamentous apparatus, vessels and nerves of the pelvic organs.
The broad ligament of the uterus (lig. latum) is a duplication of the peritoneum located on the sides of the uterus. The peritoneum is tightly connected to the anterior and posterior surfaces of the uterus, and at the edge it passes in the form of two sheets into a broad ligament that goes to the lateral walls of the pelvis, where it continues into the parietal peritoneum. Between the sheets of the broad ligament there is a layer of loose tissue with vessels and nerves. Moreover, in the upper part there are almost no vessels, and the lower part is a massive formation with vessels, nerves, and a ureter passing here. This lower part of the broad ligament is called the cardinal ligament (lig. cardinale) or Mackenrodt's ligament and consists of an accumulation of connective tissue at the level of the internal cervical os.
The suspensory apparatus of the uterus, tubes and ovaries is represented by ligaments that connect them to the walls of the pelvis and to each other.
Under the anterior leaflet of the broad ligament is the round uterine ligament (lig. teres uteri), which runs from the tubal angle of the uterus to the internal opening of the inguinal canal, it passes through it and branches fan-shaped in the thickness of the labia majora. The round ligament is a paired formation, along its lower edge are blood vessels that anastomose with each other the branches of the uterine and external genital artery and vein.
The proper ligament of the ovary (lig. ovarii proprium) is a paired short formation that runs from the angle of the uterus below the origin of the fallopian tube to the inner pole of the ovary and then along its edge to the posterior leaflet of the broad ligament.
The supporting (suspensory) ligament of the ovary (Lig. suspensorium ovarii) or infundibulopelvic ligament is a paired formation originating from the lateral part of the broad ligament between the ampulla of the tube and the pelvic wall in the area of the sacroiliac joint. The ligament holds the ampullar end of the tube and the ovary in a suspended state. The ovarian artery and vein pass through it.
The sacrouterine ligaments (lig. sacro-uterina) are paired, located under the peritoneum and extend from the posterior surface of the uterus slightly below the internal os of the uterus, arcuate around the rectum and end on the inner surface of the sacrum.
The ureters are located behind the peritoneum, bending over the terminal line of the pelvis in the area of the sacroiliac joint, passing over the iliac vessels. On the left, the ureter is located above the common iliac artery above its division into internal and external, and on the right, it bends over the vessels below the division. Then it descends into the pelvis, passing medially from the hypogastric artery. At first, the ureter runs parallel to the course of the ovarian vessels, located medially from them. Descending from the terminal line, it is directed along the lateral wall of the pelvis and separates from the ovarian vessels, forming an arc with an outward convexity, after which it departs from the lateral wall of the pelvis and passes along the posterior leaflet of the broad ligament. Here it lies at its base and for several centimeters goes together with the uterine artery, then approaches the cervix and at a distance of 2-3 cm from the rib crosses the uterine artery, located above the ureter. Then the ureter turns forward and inward, passes the cervix, touching the anterior wall of the vagina, and enters the bladder.
The sources of blood supply to the internal genital organs are the ovarian arteries (aa. ovarica), which originate directly from the aorta, and the uterine arteries (aa. uterina), which originate from the hypogastric arteries (aa. hypogasirica).
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