PELVIS MINOR 415 



media (O.T. superior false ligament) extends from the anterior 

 end of its upper surface, i.e., the apex of the bladder, to the 

 posterior surface of the anterior abdominal wall. It is caused 

 by the projection of the ligamentum umbilicale medium, which 

 consists of the urachus, a fibrous remnant of part of the 

 cloaca, and it separates the paravesical and supravesical 

 fossae from the corresponding fossae of the opposite side. The 

 peritoneum extending from each lateral border of the upper 

 surface of the bladder to the side wall of the pelvis constitutes 

 a lateral false ligament, and forms the floor of the correspond- 

 ing paravesical fossa. Not uncommonly each lateral false 

 ligament and the peritoneum on the upper surface of the 

 bladder are divided into anterior and posterior portions by 

 a transverse fold, the plica vesicalis transversa, which crosses 

 from one side of the superior aperture of the pelvis minor 

 to the other. It is questionable if the term posterior false 

 ligament should be retained ; it is still applied, however, to 

 the remnants of the sacro-genital folds which extend from the 

 back of the distended bladder to the sides of the distended 

 rectum, or to the front of the sacrum. 



Dissection from above. All the peritoneum above the 

 level of the pelvic brim should now be removed, care being taken 

 not to injure or displace the ureter or the ductus deferens. The 

 dissector should then stitch the ureter to the artery it crosses at 

 the brim, common or external iliac as the case may be. He must 

 also stitch the ductus deferens to the external iliac artery, close 

 to the origin of the inferior epigastric branch. That being 

 done, he must carefully detach the peritoneum from the extra- 

 peritoneal fat, separating any adhesions with the knife. The 

 separation should be commenced at the brim, and be carried 

 medially until the root of the pelvic meso-colon, the side of the 

 rectum, and the lateral border of the upper surface of the bladder 

 are reached. 



When that stage has been attained on both sides, the dissector 

 should displace the bladder backwards, and pass his finger 

 down between the viscus and the symphysis, through the soft 

 extraperitoneal fat, till it meets a resisting membrane. The 

 membrane is the visceral layer of the pelvic fascia or upper 

 layer of the fascia of the pelvic diaphragm. By his sense of 

 touch the dissector will recognise not only that it is attached to 

 the lower part of the posterior surface of the symphysis, but 

 also that two thickened bands of its substance extend backwards, 

 one on each side of the median plane, from the back of the 

 symphysis to the anterior border of the bladder. The bands 

 are the anterior true ligaments of the bladder or the medial 

 pubo-prostatic ligaments, the latter name indicating that, in 

 the male, they are placed above the prostate. Having satisfied 

 himself regarding the pubo-prostatic ligaments, the dissector 

 should carry his finger backwards, between the bladder and the 



