PELVIS AND PERINEUM

1
PELVIS AND PERINEUM
2
Bony Pelvis

• Review bones of pelvic girdle.
• Pelvic brim
• superior outlet.
• Boundaries
• Sacral promontory.
• Arcuate lines.
• Iliopectineal line of pubis.
• Greater (false) pelvis
• expanded area above pelvic brim.

3
Bony Pelvis

• Pelvic outlet
• Bounded by
• Coccyx, sacrotuberous ligaments, ischial
  tuberosities, ischiopubic rami, pubic
  symphysis.
• Lesser pelvis
• Portion of bony pelvis below pelvic brim.
• Closed below by pelvic diaphragm.

4
Pelvic Diaphragm

• Levator ani
• Consists of
• Puborectalis
• forms a sling around anorectal junction.
• Pubococcygeus.
• Iliococcygeus.

5
Pelvic Diaphragm

• Levator ani
• Forms muscular sling supporting pelvic
  organs.
• Incomplete anteriorly to allow for passage of
  urethra and vagina.
• Ischiococcygeus.

6
Urogenital Diaphragm

• Layer of skeletal muscle between two layers of
  fascia
• Penetrated by membranous urethra (male and
  female) and vagina.
• Ischiorectal fossa
• Wedge-shaped space between
• Anal canal, obturator internus, pelvic
  diaphragm, skin.

7
Perineum

• Diamond-shaped area below pelvic
• Diaphragm
• Same boundaries as inferior pelvic aperture.
• Divided into two triangles
• Anal triangle.
• Urogenital triangle.

8
Viscera of Male Pelvis

• Seminal vesicle.
• Ductus deferens.
• Ejaculatory duct.
• Prostate gland.
• Urethra
• Prostatic.
• Membranous.

9
Viscera of Female Pelvis

• Ovaries.
• Uterine tube (Fallopian tube oviduct)
• Infundibulum.
• Ampulla.
• Isthmus.
• Intramural part.
• Uterus
• Body.
• Fundus.
• Cervix.

10
Viscera of Female Pelvis

• Ligaments
• Broad ligament
• Formed by two layers of peritoneum.
• Contains
• Uterine tube.
• Round ligament of uterus.
• Ligament of the ovary.
• Uterine vessels.
• Vagina.

11
Arteries of Pelvis

• Internal iliac artery
• Arises from common iliac artery anterior to
  sacroiliac joint.
• Supplies
• Perineum.
• Gluteal region.
• Pelvic organs and walls.
• Divided into anterior and posterior divisions.

12
Arteries of Pelvis

• Internal iliac artery
• Anterior division
• Umbilical artery.
• Obturator artery.
• Inferior gluteal artery.
• Internal pudendal artery.
• Inferior vesical artery.
• Middle rectal artery.
• Uterine arteries.
• Vaginal artery.

13
Arteries of Pelvis

• Internal iliac artery
• Posterior division
• Superior gluteal artery.
• Iliolumbar artery.
• Lateral sacral artery.
• Other arteries of the pelvis
• Ovarian artery.
• Superior rectal artery.
• Median sacral artery.