566 



THE BLOOD-VASCULAR SYSTEM. 



Peculiarities. The internal pudic is sometimes smaller than usual, or fails to give off one 

 or two of its usual branches ; in such cases the deficiency is supplied by branches derived from 

 an additional vessel, the accessory pudic, which generally arises from the internal pudic artery 



before its exit from the great 

 sacro-sciatic foramen. It 

 passes forward along the 

 _ lower part of the bladder 

 Deep 



circumflex 

 iliac 



Ileo-lumbar 



Lateral 

 sacral 



Deep 

 epigastric 



Deep . 

 epigastric 



Obturatm 



and across the side of the 

 prostate gland to the root 

 of the penis, where it per- 

 forates the triangular liga- 

 ment and gives off the 

 branches usually derived 

 from the pudic artery. The 

 deficiency most frequently 

 met with is that in which 

 the internal pudic ends as 

 the artery of the bulb, the 

 artery of the corpus cav- 

 ernosum and arteria dorsalis 

 penis being derived from 

 the accessory pudic. Or the 

 pudic may terminate as the 

 superficial perineal. the ar- 

 tery of the bulb being de- 

 rived, with the other two 

 branches, from the acces- 

 sory vessel. Occasionally 

 the accessory pudic artery 

 is derived from one of the 

 other branches of the in- 

 ternal iliac, most frequently 

 the inferior vesical or the 

 obturator. 



Surgical Anatomy. 

 The relation of the acces- 

 sory pudic to the prostate 

 gland and urethra is of the 

 greatest interest in a surgi- 

 cal point of view, as this 

 vessel is in danger of being 

 wounded in the lateral 

 operation of lithotomy. The 

 student should also study 

 the position of the inter- 

 nal pudic artery and its 

 branches, when running a 

 normal course with regard 

 to the same operation. The 

 superficial and the trans- 

 FIG. 315. The internal pudic artery and its branches in the male. (Gegenbaur.) verse perineal arteries are, 



of necessity, divided in this 



operation, but the hemorrhage from these vessels is seldom excessive ; should a ligature be 

 required, it, can readily be applied on account of their superficial position. The artery of the 

 bulb may be divided if the incision be carried too far forward, and injury of this vessel may be 

 attended with serious or even fatal consequences. The main trunk of the internal pudic artery 

 may be wounded if the incision be carried too far outward ; but, being bound down by the strong 

 obturator faseia and under cover of the ramus of the ischium, the accident is not very likely to 

 occur unless the vessel runs an anomalous course. 



Branches. The branches of the internal pudic artery are 



Muscular. Transverse Perineal. 



Inferior Hsemorrhoidal. Artery of the Bulb. 



Superficial Perineal. Artery of the Corpus CavernosuiM 



Dorsal Artery of the Penis. 



The muscular branches consist of two sets one given off in the pelvis, tt?e 

 other as the vessel crosses the ischial spine. The former are several small offsets 

 which supply the Levator ani, the Obturator internus, the Pyriformis, and the 



Int. pudic 



hsemorrhoidnl 



Perineal 



