Download Anatomy - venous and lymphatic drainage of pelvis

VENOUS AND LYMPHATIC DRAINAGE OF PELVIS
Learning Objectives
At the end of lecture the student will know:
• Main veins of the pelvis and their tributaries.
• Area of drainage of these veins.
• Different groups of lymph nodes.
• Afferent and efferent of different groups.
• Role of lymphatics and common route of spread
of malignancies of pelvis.
Veins of the Pelvis
•
Common iliac veins: Formed by the union of external and
internal iliac veins in front of sacroiliac joint.
•
Common iliac veins ends upon L4~L5 by uniting each other
to form inferior vena cava.
1-External iliac vein accompany the artery of the same name.
2-Internal iliac veins:
• These are the veins draining the pelvis.
• These veins converge near the greater sciatic foramen to form
the internal iliac vein.
It has
1. Parietal tributaries: which accompany with arteries of pelvic
wall.
2. Visceral tributaries: From the pelvic visceras
1-Parietal Tributaries.
The gluteal, internal pudendal, and obturator veins, which have their origins outside
the pelvis.
(a) The lateral sacral veins, which lie in front of the sacrum.
The Superior Gluteal Veins
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•
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These are venæ comitantes of the superior gluteal artery;
They receive tributaries from the buttock corresponding with the branches of the
artery, and enter the pelvis through the greater sciatic foramen, above the
Piriformis,
They frequently unite before ending in the hypogastric vein.
The Inferior Gluteal Veins
•
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Venæ comitantes of the inferior gluteal artery, begin on the upper part of the back
of the thigh, where they anastomose with the medial femoral circumflex and first
perforating veins.
They enter the pelvis through the lower part of the greater sciatic foramen and
join to form a single stem which opens into the lower part of the hypogastric vein
Obturator Vein
•
It begins in the upper portion of the adductor region of the thigh and enters the
pelvis through the upper part of the obturator foramen.
•
It runs backward and upward on the lateral wall of the pelvis below the obturator
artery, and then passes between the ureter and the hypogastric artery, to end in the
hypogastric vein.
Lateral Sacral Veins
They accompany the lateral sacral arteries on the anterior surface of
the sacrum and end in the hypogastric vein.
Visceral Tributries
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•
•
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Middle rectal (hemorrhoidal)
Prostatic
vesical,
uterine,
vaginal veins,
All these veins originate in the venous plexuses connected
with the pelvic viscera.
Middle Hemorrhoidal Vein
•
•
Takes origin in the hemorrhoidal plexus and receives tributaries from the bladder,
prostate, and seminal vesicle.
It runs laterally on the pelvic surface of the Levator ani to end in the internal iliac
vein.
•
The hemorrhoidal plexus surrounds the rectum.
•
The pudendal plexus lies behind the arcuate public ligament and the lower part
of the symphysis pubis, and in front of the bladder and prostate.
The prostatic veins form a well-marked prostatic plexus which lies partly in the fascial
sheath of the prostate.
• Vesical plexus envelops the lower part of the bladder and the base of the
prostate.
• The Dorsal Veins of the Penis (vv. dorsales penis) are two in number, a
superficial and a deep
Clinical Anatomy
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•
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Blockage of the veins of lower limb will result in the alternate path of the venous
blood through the pelvic veins.
Surgical interference of these veins e.g during hysterectomy may compromise
venous drainage and may precipitate the edema of one or both legs.
Veins of the rectal plexus may become varicose and may result in internal or
external hemorrhoids.
Lymphatic Drainage of Pelvis
Main Groups of Pelvic Lymph Nodes
•
Most of the lymphatic vessels from the pelvis drain
into groups of nodes associated with the iliac arteries
and their branches.
•
1-External iliac lymph nodes receive vessels from
the inguinal nodes, external genitalia, lower vagina,
and cervix; they drain into the common iliac nodes.
2- Internal Iliac Lymph Nodes
Surround internal iliac vessels.
• Internal iliac and sacral lymph nodes receive afferents
from all the pelvic viscera (e.g., cervix, prostate, and
rectum) and from the perineum, buttock, and thigh
they drain into the common iliac nodes.
•
Common iliac lymph nodes send their efferent to the lumbar group of aortic
nodes, which also receives the afferents of the testis and ovary.
•
The lower part of the anal canal, as also the external genitalia, drains into the
inguinal nodes.
External iliac lymph nodes
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Lie along external iliac artery.
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They are 4- 6 in number.
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Receive afferents from lower limb and some parts of pelvic viscera and also from
sacral lymph nodes.
Common iliac lymph node
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Lie along common iliac artery
Receive afferents from all the above nodes
Efferent pass to the lumbar lymph node
Lymphatic Drainage of Pelvis