Small pelvis
Last reviewed: 23.04.2024
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The cavity of the small pelvis is lined with the peritoneum, which covers all the internal genital organs except the ovaries. The uterus is located in the center of the pelvis, anterior to it is the bladder, back - the rectum.
Between the uterus and the bladder a cavity is formed - the vesicle-uterine space (excavatio vesico-uterina), in which the filling bladder is designated as a spherical bulge.
The rectum-uterine space (Douglas pocket) (excavatio recto-uterina Douglasi) is deeper, a rectum in the form of a short narrow tube, descending down the sacral cavity.
From the bottom of the uterus, the uterine tubes (tubae uterinae) located in the upper part of the broad ligament (lig. Iatum) between its leaves depart from the bottom of the uterus, above and behind the place of divergence of the circular ligament. When departing from the uterus, the tube is thin, then gradually widens and ends with a funnel, which has an opening of up to 0.5 - 1.0 cm in diameter, surrounded by pili. Fimbria approaches the ovary and, as it were, covers it. Fallopian tubes are mobile due to a mesenteric moss (mesosalpinx) consisting of a perforated duplication connected to a broad ligament.
Ovaries are located along the lateral walls of the pelvis in a special depression of the parietal peritoneum behind the wide ligament of the uterus, laterally and posteriorly. By means of their own ligament (lig. Ovarii proprium), they are attached to the corner of the uterus on one side, and on the other hand, using the funnel-pelvic ligament (lig. Infundibulo-pelvicum. S. Lig. Suspensorium ovarii) to the side wall of the pelvis. Between the leaves 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, encompassing the edge of the ovary in the form of a rim. This is the so-called gate of the ovary (hilus ovarii), where the vessels and nerves pass.
The ovary and the fallopian tube are closely adjacent to the ureter, which passes at the medial and posterior sides of the ovarian fossa (fossa ovarica) parallel and from the inner side of the funnel-pelvic ligament, the ventral end of the tube is separated from it only by the fold of the peritoneum.
Under the peritoneum, covering the organs of the small pelvis, there are fiber, ligamentous apparatus, vessels and nerves of pelvic organs.
A wide ligament of the uterus (lig. Latum) is a duplicate of the peritoneum located on the sides of the uterus. The peritoneum is tightly connected to the anterior and posterior surface of the uterus, and at the rib it passes in the form of two leaves in a wide bundle, going to the side walls of the pelvis, where it extends into the parietal peritoneum. Between the leaves of the broad ligament is laid a layer of loose fiber with blood vessels and nerves. And in the upper part of the vessels there is almost no, and the lower part is a massive formation with vessels passing here, nerves, ureter. This lower part of the broad ligament is called the cardinal ligament (lig. Cardinale) or the Mackenrod ligament and consists of a cluster of connective tissue at the level of the internal uterine throat.
Suspension apparatus of the uterus, tubes and ovaries is represented by ligaments connecting them to the walls of the pelvis and to each other.
Under the front sheet of the broad ligament there is a round uterine ligament (lig. Teres uteri), extending from the tube corner of the uterus to the inner opening of the inguinal canal, it passes through it and fan-shaped branched in the thickness of the large labia. A round ligament is a pair formation, along the lower edge of it there are blood vessels that anastomize between the branches of the uterine and external genital arteries and veins.
The ovary's own ligament (lig. Ovarii proprium) is a pair of short formations that extend from the corner of the uterus below the uterine tube to the inner pole of the ovary and further along its rib to the back sheet of the broad ligament.
The supporting (suspending) ovarian ligament (Lig. Suspensorium ovarii) or the voroncatous 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 region of the sacroiliac joint. The binder keeps the ampullar end of the tube and the ovary in a suspended state. In it pass the ovarian artery and vein.
The sacro-uterine ligaments (lig. Sacro-uterina) are paired, located under the peritoneum and extend from the posterior surface of the uterus slightly below the internal uterine pharynx, arcuate the rectum and terminate on the inner surface of the sacrum.
The ureter lies behind the peritoneum, bends over the terminal line of the pelvis in the region of the sacroiliac joint, passing over the iliac vessels. To the left, the ureter is located above the common iliac artery above the dividing line into the inner and outer arteries, while on the right it is bent through the vessels below the division. Then he descends into the pelvis, passing medially from the hypogastric artery. Initially, the ureter goes parallel to the course of the ovarian vessels, located inward from them. Going down from the terminal line, it goes along the side wall of the pelvis and separates from the ovarian vessels, forming an arch with a convex outward, after that it departs from the lateral wall of the pelvis and passes along the back sheet of the broad ligament. Here it lies at its base and for a few centimeters goes along with the uterine artery, then comes to the cervix and at a distance of 2 - 3 cm from the rib crosses the uterine artery located above the ureter. Further the ureter turns forward and inside, passes the cervix, touching the front wall of the vagina, and enters the bladder.
Sources of blood supply of internal genital organs are ovarian arteries (aa. Ovarica) that drain directly from the aorta, uterine arteries (aa. Uterina) originating from hypogastric arteries (aa., Hypogasirica).
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