PELVIS 625 



broad ligament, and then turn the membrane behind the incision medially 

 from the side wall of the pelvis to the rectum. When this has been done 

 and the extra-peritoneal fat has been dissected away, the ureter, the divisions 

 and branches of the hypogastric artery, the accompanying veins, and 

 the pelvic plexuses of the sympathetic passing forwards at the sides of 

 the rectum, will be exposed. Whilst this stage of the dissection is pro- 

 ceeding care must be taken to avoid injuring the parietal or the visceral 

 pelvic fascia. The hypogastric vessels lie inside the fascia, and their 

 visceral branches pierce the visceral layer, whilst the parietal branches 

 pierce the parietal layer. The main nerve trunks and the cords of the 

 sympathetic are outside the parietal fascia ; therefore their branches do not 

 pierce the fascia as they pass out of the pelvis. The obturator nerve, 

 however, pierces the parietal pelvic fascia from without inwards at the 

 posterior part of the pelvis, and runs forwards lateral to the hypogastric 

 vessels and below the pelvic brim to the upper part of the obturator foramen, 

 where it enters the obturator canal through which it passes into the thigh. 



When the extra-peritoneal fat has been removed, the 

 general positions of the structures behind the broad ligament 

 should be noted (Figs. 248, 249). The hypogastric artery 

 serves as a prominent landmark as it descends at the junction 

 of the lateral with the posterior wall of the pelvis. In front 

 of the hypogastric artery the ureter runs downwards till it 

 reaches the level of the visceral layer of the pelvic fascia, 

 then it turns forwards and medially to the lateral angle of the 

 bladder. In this part of its course it passes beneath the 

 lower border of the broad ligament and the uterine artery, 

 and obliquely above and in front of the upper end of the 

 vagina. 



The student should verify the important relations of the 

 ureter to the vagina and to the uterus by passing a finger 

 into the vagina, and noting that when the tip of his finger lies 

 at the top of the vagina and at the side of the lower end of 

 the uterus it is immediately below the medial part of the lower 

 border of the broad ligament, and that the ureter passes 

 obliquely from behind forwards and medially across it. 



Running forwards on the lateral wall of the pelvis, and 

 passing to the lateral side of the ureter will be found the 

 obliterated part of the umbilical artery and the obturator 

 nerve and vessels. In the female the obliterated part of the 

 umbilical artery is frequently below the level of the obturator 

 nerve behind the broad ligament, but it rises above the nerve 

 as it passes forwards. The uterine artery will be found 

 descending in front of the ureter before it turns medially to 

 cross above the duct beneath the lower border of the broad 

 ligament. The hypogastric vein lies behind the stem of the 



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