. lt distributes largely outside the pelvis & gives an acetabular branch. PELVIS & PERINEUM PELVIS & PERINEUM I 'urqiEa@Itgivesapubicbranchwhichanastomoseswiththepubicbranch of inf epigastric a - Abnormal obturator artery (see above). 3) Middle Rectal arterv: anastomoses with sup & inf rectal arteries.

 

2) Deep external sphincter.

3) Puborectalis except anteriorly.

Surgical importance:

Damage of this ring results in incontinence (it must be protected

during the removal of fistulous track)

RglArlons: See above ( Relations of the rectum ).

MuCOSA OF THE ANAL CeueI:

Dentate (Pectinate) line divides the anal canal into 2 parts

lrnrdca; Ycku:

FErn intador mB6sfitort artsry To parlal t,€fiorrE 6t sl6fi

I Visosrsl motor{mircd

syrnpsthotic and ptrEryltp*hatic)artd

srn$ory lnneruelirn t

Fbe$nstqlir6---

+

Lynghatlce:

To htarrd ilar

lyrnph nodec

t

Poclinab liiE i

To supe*hhl

inguinal

lyrnph node*

I Somalii mo{s and

sGnsory inneletigr

FtEm hlEinal ilae ertsry To cfi.El v*rEus €y3tEm

Saparafim sI'ei*esml'fld 'parhhl' at lhs pscUnale lins

Proctodeum = ectoderm

Pecten & skin (stratified

squamous epithelium)

Middle & inferior rectal

vessels (systemic)

lnternal iliac LNs

Present

PELVIS & PERINEUM I

Bgloosotflriliil*

I cohmnarmm

I &ral@*n

I &*ryleausilno

GftilBrff*docod

Loryru.ffil fl]Eolec{d

inmcellr$o[ hrbdofinC

rdSdn6.lsr

hHulrH

Poctrsb rEeillqlw$l

Ofimcl*ur* p&omeubdil*dh

G.mmtru dft

POINTS OF SURGICAL ITUPONTANCE:

- Above the pectinate line, there is no abrupt change in the epithelium.

- lt is continually closed except for passage of feces & flatus.

- There is porto-systemic anastomosis halfiuay down the canal.

The Anal columns:

o These consist of 5 to 10 vertical folds of mucous membrane overlying

verns.

o Are connected by mucosal folds known as analvalves.

o They are separated by grooves.

EUM

lo.do

ollurulo( lnhmJJ

oni d

frxrrol phk lonir

orund radum

h[tor mi

tupaic lwio of

prlvic rliopirogm

lnhdrx lo*io cl

pchic rfiophregm

lml

.rsl

Sptinaa oni

arlrmuS

-

jlhis is a wedge shaped space situated on either side of the anal canal. {* BouruoRnres:

. AEE white line directed upwards, meeting of lateral & medial

walls

. Base: directed downwards, formed by perineal skin & fascia on

either sides of the anal orifice

. fu1!g4!rygl!-: lower part of deep perineal pouch

. Posterior wall: sacrotuberous ligament

. MegljeLlgelli lower surface of levator ani and external anal sphinctre

. t4!E|1g3!!j obturator internus musde and ischial tuberosity

Corurerurs:

. Large pad of fat

. Alcock's(pudendal ) canal

o pudendal n. & internal pudendal vessels + their branches :

Obtrettr htErus

nRJsle

Tsrldtrr of obturattr

ht€rrus musclo

bcfiio-and fossae

AnBrior rEsesBec {il

ischb-anal toss*

lxhhl

lub.r6iry

PELVTS & PERTNEUM r

{F,

E,tnmorucw

Elertoruu

Root of the penis (or clitoris)

Superficial perineal muscles

Posterior scrotal (or labial) nerves & arteries

Dorsal nerve of the penis

Deep dorsal vein of the penis

Terminal branches of internal pudendal artery

Penile urethra

ies between the perineal membrane & Colle's fascia

oiu$noamDooh

4oghemga{e

r-<

E!h

Gndvgtfllrtreh0d

Bbnilmuml

lhCrdailG.

Exhmd amls9ilficts

{fr conrenrs:

{f Suncrcll lruponreruce :

Rupture of penile urethra leads to extravasation of urine in the

pouch & may extend to the anterior abdominalwall deep to Scarpa's

fascia, upper part of the thigh, scrotum & penis

However, urine is prevented from entering the thigh due to:

breadth below the inguinal ligament.

I PELVIS & PERINEUM

It is a closed space , Lies between perineal membrane & urogenital diaphragm

Corurerurs:

1- Membranous urethra 3- Sphincter urethrae

2- Bulbourethral glands 4- Deep transversus perinea

lhepdorud vsh d pmls lrftriorp*ic liFllurfr

-/\l a) Ilorsal rclve d penb

Antsiors@ tlasdabrysf psnis

of pedneal

mamb,rsne E&mal rffithd

drincbrmus&

\

Ileeptamwrm psrinalm

PELVIS & PERINEUM I

" Aleoek's Canal n

lnltslorrectl ruy

lsctriosnal

Ertsndaml spl*ndar

A *rurtorvtal

Enorhrrodd uoh

lflrlrtgnolrl ualn

transrsrus rodal lold

frecal vemut pl€ilul

Horlor rua,|il rtln

hbmd nsmontdd

Ext8malhemffifsil

etrsrdllrn

,t

n

TpELVts & PEHTNEUM

THe IrureRrunI ILIAc ARTERy

$FEflOR

frmrf,onlhc ilt|fy

[*.ildk

Efiormllhcaffiy

AnNbrilUondhlMdn*shry

lllllltcela&IOf,bril

0mulbrdftry

fl{ImmB

mdum@lbauafil

Suprlorvsdedilbdrs

IdalUHFrE$r.3.fl)

flhemhriruy

*&rncibrffir

frd0rlordirEbn of lnHfid f;hc $HI

Srysbr0luisol artsy

cub6lffsy

Uhrhodldy

Frdfixhlat*f

P0$itBoB

O RIC ltt : At sacroiliac joint as the smaller of the 2 terminal branch of common iliac

a.

Ettos:

- ln the pelvis near the upper part of the greater sciatic foramen.

- lt divides into anterior & posterior divisions which gives the terminal branches

BnnucHES

l. Anterior division:

A- Branches common in C & ?:

1) Umbilical arterv

. Gives 2 or 3 superior vesical arteries, then the distal part of

becomes fibrosed forming the lateral umbilical lig & reaches

the neck of umbilicus.

Surgica! lmportancei.lt divides triangle of Hasselbach into

2)

medial & lateral parts.

Obturator arteru

. lt passes through the obturator canal & obturator foramen

with the obturator nerve

. lt divides into posterior & anterior branches

. lt distributes largely outside the pelvis & gives an acetabular

branch.

PELVIS & PERINEUM 

PELVIS & PERINEUM I

'urqiEa@Itgivesapubicbranchwhichanastomoseswiththepubicbranch

of inf epigastric a

- Abnormal obturator artery (see above).

3) Middle Rectal arterv: anastomoses with sup & inf rectal arteries.

B- Branches specific to Males

trntBmal

Oonmon illac

artBry

lntemal

erEry

Erilamal iliao

erlery