1382 



CLINICAL AND TOPOGRAPHICAL ANATOMY 



by the spermatic or ovarian vessels. It crosses the brim of the pelvis just in 

 front of the bifurcation of the common iliac, and descends on the side wall of the 

 pelvis in front of the hypogastric artery. 



The abdominal part of the ureter may be exposed extraperitoneally by an extension for- 

 ward of the usual lumbar renal incision. It is found lying between peritoneum and psoas 

 3.7 cm. (I5 in.) from the middle line and when the peritoneum is stripped from the posterior 

 abdominal wall the ureter is invariably carried with it. 



Aorta and iliac arteries. — The aorta enters the abdomen opposite the last 

 thoracic vertebra, a point 12 to 15 cm. (5 to 6 in.) above the umbilicus, or rather 

 above the mid-point between the infrasternal depression and the umbilicus 

 (Thane and Godlee), and thence, lying to the left of the mid-line, divides into the 

 two common iliacs opposite the disc between the third and fourth lumbar vertebrse, 

 or opposite the body of the fourth lumbar vertebra. This point is about 2.5 

 'cm. (1 in.) below and to the left of the umbilicus, and on a level with a line 

 drawn across the highest part of the iliac crest. A line drawn from this point, 

 with a slight curve laterally, to just medial to the centre of Poupart's ligament, 

 will give the line of the iliac arteries; the upper third of this line giving the aver- 

 age length of the common iliac. The relation of the common iliac veins is shown 

 in fig. 1112. The right, much shorter than its fellow, lies at first behind and 

 then somewhat lateral to its artery. The left is at first to the medial side of 

 its artery, and then behind the right. At the upper part of the fifth lumbar 

 vertebra behind and lateral to the right artery, the vena cava begins. 



The site of some of the branches of the aorta may be thus approximately 

 remembered as follows : The coeliac artery is given off immediately after the aorta 

 has perforated the diaphragm; directly below this is the superior mesenteric 

 artery. About 2.5 cm. (1 in.) lower down, or 7.5 cm. (3 in.) above the umbilicus, 

 the renal arteries are given off. About 2.5 cm. (1 in.) above the umbilicus would 

 be the level of the inferior mesenteric artery. The relation of the above vessels to 

 the transpyloric line (p. 1153) is as follows: (Stiles.) The coeliac artery is two 

 fingers' breadth, the superior mesenteric one, above the line, the renal arteries are 

 a finger's breadth below it. The origin of the inferior mesenteric is midway be- 

 tween the transpyloric and intertubercular lines. 



Collateral circulation after ligature of the common iliac. — The chief vessels here are: — • 



Pubic branch of inferior epigastric with 



Internal mammary and lower intercostals with 



Lumbar with 



Middle sacral with 



Superior ha^morrhoidal with 



Ovarian with 



Pubic branch of obturator. , 



Inferior epigastric. 



Ilio-lumbar and circumflex iliac. 



Lateral sacral and superior gluteal. 



Inferior and middle haemorrhoidal. 



Uterine 



Collateral circulation after ligature of the external iliac : — 

 Internal mammary, lower intercostals, \ •■ 1 



and lumbar. / ^'^^ 



Ilio-lumbar, lumbar, and gluteal with 



Internal and external circumflex with 



Perforating branches of profunda with 



Circumflex and epigastric with 



External pudic with 



Inferior epigastric. 



Deep circumflex iliac. 



Superior and inferior gluteal (sciatic). 



Inferior gluteal (comes nervi ischiadic!). 



Obturator. 



Internal pudic. 



Collateral circulation after ligature of the internal iliac : 



Branches of profunda with 



Inferior mesenteric with 



Ve.s.sel of opposite side with 



Branches of opposite side with 



Superior and inferior gluteal (sciatic) with 



Middle sacral with 



Ilio-lumbar and superior gluteal with 



Inferior gluteal (sciatic). 



Haemorrhoidal arteries. 



Pubic branch of obturator. 



Branches of pudic. 



Circumflex and perforating of profunda. 



Lateral sacral. 



Circumflex iliac. 



THE PELVIS 



The male pelvis will be considered first, then the female pelvis, and finally a 

 section on hernia. 



The Male Pelvis 



The topics under this heading will be considered in the following order: 

 boundaries and subdivisions, scrotum and testis, ductus deferens and spermatic 



