Blood vessels, lymph nodes and innervation of

urogenital organs

The Retroperitoneum

David Sedmera

Sec. Miloš Grim & Petr Valasek

Institute of Anatomy

First Faculty of MedicineMarch 2020

Why retroperitoneum?

• Deep body (what‘s left in the body after

we remove the innards)

• Abdominal aorta and its branches

• Inferior vena cava and its tributaries

• Lymphatics (nodes and collectors)

• Nerves – L-S plexus and the

autonomics

• Organs

Clinical notes

• Abdominal aorta - aneurysm

• Inferior vena cava - trombosis

• Lymphatics - metastasis

• Organs – access to the kidney, adrenal

gland

• Nerves – regional anaesthesia

Nerves of the retroperitoneal and subperitoneal space

Lumbal and sacral plexuses,

Abdominal and pelvic plexuses and

ganglia of the autonomic system

Vena cava inferior, aorta abdominalis, a. mesenterica inferiorPortal circulation vs. inferior v. cava; porto-caval anastomoses

Porto-caval anastomoses

• Cardia-esophagus (varices – bleeding)

• Rectum - hemorrhoids

• Parietal branches and retroperitoneal

parts of the colon, spleno-renal shunt

• Periumbilical veins (caput Medusae)

• Intrahepatic, patent ductus venosus

Lymph nodes in the

retro- a sub-peritoneal

space

Cross-section of the abdomen

Mid-sagittalsection of

the abdomen

• Body wall

• Peritoneal cavity

• Omental bursa

(lesser sac, in blue)

• Retroperitoneum

• Branches of the

abdominal aorta:

-parietal (paired)

-visceral -paired

-unpaired

-terminal: AIC (2x)

median

sacral a,

Retroperitoneal space, topography of its organs and main vessels

Vessels of pelvic organs

venous vesical plexus, venous vesicovaginal plexus

Male vs. female

Female pelvis, transverse cross-section

Female pelvis, fixation of the uterus

Principle of blood supply to the pelvic organs

Blood supply to the uterus

Arteries of the

pelvis

AA AIC

AIC

AIE

AII

A. iliaca

interna

Vena iliaca interna

Clinical note:

bleeding!

Lymph nodes on

posterior abdominal

wall and sides of pelvis

If you know the blood

supply of the organs…

you know the lymphatic

drainage!

Important: uterus

(multiple sources/lymph

node groups)

testis (NOT the inguinal

lymp nodes!)

Lymphaticdrainage ofthe uterus & other female

genitalorgans

• Multiple blood

supply of the

uterus –

anastomoses:

-via the ovarian

aa.

-uterine artery

-vaginal artery

-along the

round ligament

Lymphaticdrainage of

the male genitalorgans

• Blood supply to

the testis!

• Embryology is

the key…

Lymphaticdrainage ofthe urinary

system

• Inguinal lymph

nodes

• External iliac l.n.

• Internal iliac l.n.

• Common iliac l.n.

Lympnodes of

the rectum

• 3 arteries

=> 3 ways

of

lymphatic

drainage!

Nodi lymphatici pelvici

Internal iliac artery, blood vessels of the pelvis

Lacuna vasorum, lac. musculorum, canalis obturatorius

Foramen supra- and infrapiriforme

Perineal region - blood supply, innervation

Pudendal nerve and Internal pudendal artery

Plexus hypogastricus Inferior,

parasympathetic fibres from the

sacral nerves

Function!

Pudendal nerve block

during childbirth

• Next to the sacro-

spinous ligament

Episiotomy

• To do, or not

to do?

- culture

- wishes

- age & parity

- always with

the forceps

delivery

• During delivery – to avoid tear to the rectum

Figure credits:

Gray´s Anatomy,

Sobottův atlas anatomie člověka, Grada, 2007

Grim, Druga: Základy anatomie, 5. díl

Benninghoff, Drenckhahn: Anatomie I., II.

Carlson,B.M.: Human Embryology and Developmental

Anatomy, archive of the authors

Recommended reading (additional to Sobotta‘s):

Čihák R: Anatomie 2, Grada 2002, (3. vydání březen 2013)

Grim, M., Druga, R.et al: 5. Anatomie krajin těla. Praha,

Karolinum, Galén, 2010; 3. Trávicí, dýchací, močopohlavní a

endokrinní systém, Praha, Karolinum, Galén, 2005,

Lüllmann-Rauch R.: Histologie, překlad 3. vydání , Grada 2012

Sadler T. W: Langmanova lékařská embryologie, překlad 10.

vydání , Grada 2011,

Junqueira´s Basic Histology 12th Edition, 2010