562 ABDOMEN 



the region of the ureter, and afterwards from the hypogastric vessels and 

 their branches and tributaries. Whilst this is being done, the obturator 

 nerve will be brought into view to the lateral side of the ureter, and 

 below the level of the umbilical artery. Whilst removing the fat and 

 displaying the structures embedded in its substance, the dissector must 

 be careful not to injure either the parietal or the visceral pelvic fascia. 

 He will find that some of the branches of the hypogastric artery pierce the 

 parietal fascia as they leave the pelvis, and that the visceral branches, the 

 rectum, the ureter, and the ductus deferens, pass into the substance of the 

 visceral layer. 



When the dissection is completed the student should note 

 the relative positions of the structures he has exposed. The 

 ductus deferens will be seen passing downwards and backwards, 

 on the side wall of the pelvis, till it meets the ureter, 

 which is passing downwards, from the junction of the 

 lateral and posterior walls of the cavity and along the front 

 of the hypogastric artery. Before they meet both the ductus 

 deferens and the ureter turn medially and, medial to the point 

 of crossing, they both enter the visceral layer of the pelvic 

 fascia. Behind the ureter is the hypogastric artery dividing 

 into its anterior and posterior divisions. Running forwards 

 on the lateral side of the ureter and the ductus deferens 

 are the umbilical, the obturator, the middle and inferior 

 vesical, and, not uncommonly, the middle haemorrhoidal 

 branches of the anterior division of the hypogastric artery. 

 Springing from the umbilical artery are one or more superior 

 vesical arteries, whilst below the umbilical artery and above 

 the obturator artery is the obturator nerve, which pierces 

 the parietal fascia at the back of the pelvis and runs 

 forwards, above the corresponding artery and vein, to the 

 obturator canal. Behind the ureter the lateral sacral 

 branches and the gluteal continuation of the posterior 

 division of the hypogastric artery will be seen piercing the 

 pelvic fascia, and when the posterior division of the artery is 

 displaced medially its ilio-lumbar branch will be found. The 

 hypogastric vein lies along the posterior border of the artery, 

 and those of its tributaries which correspond to the anterior 

 branches of the artery pass, usually, to the medial side of 

 the anterior division of the artery on their way to the main 

 vein. There is no vein with the umbilical artery or its 

 superior vesical branch. As a rule only one vein accompanies 

 the obturator artery, but the inferior vesical and middle 

 haemorrhoidal veins are usually numerous, and, as they pass 

 to their termination, they ensheath the lower part of the 



