THE FEMALE PELVIS 393 



layer of the broad ligament, which it draws out to form the 

 mesovarium. It is covered by peritoneum which is somewhat 

 altered in character, and which is termed " germinal epithelium." 



In nulliparae, the ovary lies on the side wall of the pelvis 

 in a small peritoneal recess, termed the fossa ovarica, which is 

 limited above by the external iliac vessels and behind by the 

 ureter. Its medial surface is related to the uterine tube, and 

 its anterior border is connected to the posterior layer of the 

 broad ligament by the mesovarium. From its upper pole, 

 which gives attachment to the fimbria ovarica, the peritoneum 

 passes to the side wall of the pelvis as the suspensory ligament. 

 The lower pole of the ovary is attached to the uterus by a 

 fibro-muscular band, known as the ovarian ligament. 



The Ovarian Artery arises from the aorta opposite the 

 second lumbar vertebra, and passes downwards and laterally 

 on the psoas major to reach the brim of the pelvis, where it 

 enters the suspensory ligament. It gives off a few twigs to the 

 uterine tube, and one or two branches which run medially in the 

 mesosalpinx to anastomose with the uterine artery, but the 

 main stem of the vessel enters the mesovarium to supply the 

 ovary. In the latter part of its course the artery is very tortuous, 

 and is surrounded by the pampiniform plexus of veins, which 

 unite to form the ovarian vein in the suspensory ligament. 



Owing to the free anastomosis of the ovarian and uterine 

 arteries, the peritoneum on each side of the ovary must be 

 seized with forceps when the organ is being removed. Ligature 

 of the vessels should be carried out by transfixing the broad 

 ligament, otherwise the sutures may slip and give rise to 

 troublesome haemorrhage owing to the retraction of the cut 

 vessels. 



Dermoid or other cysts arising in connection with the ovary 

 may or may not possess a pedicle of peritoneum. When they 

 do, the pedicle consists of the mesovarium and its contained 

 vessels. Twisting of the pedicle produces kinking of the artery 

 and cuts off the blood-supply of the tumour. In other cases, 

 the cyst may grow in between the two layers of the broad ligament, 

 and separate them as it enlarges. The peritoneum may be 

 stripped off the pelvic wall and the iliac colon, and the 

 commencement of the pelvic colon may be denuded. When 

 the tumour is removed, great care must be exercised lest these 

 parts of the bowel be injured, as they are in intimate relationship 

 with it. 



