Presentation on theme: "Avascular Spaces of the Pelvis"— Presentation transcript:
1 Avascular Spaces of the Pelvis (Where the blood vessels are not!!!)
2 Avascular SpacesPotential spaces—filled with fat and connective tissueEight spaces: (four midline and four lateral)Lateral spaces: Pared pararectal and paravesical spaces(both can be used to ligate hypogastrics)Midline spaces: Prevesical space, vesicouterine space,rectouterine space, retrorectal spaceEach pelvic organ can be separated from theothers by opening avascular spaces.
3 Endopelvic FasciaThe endopelvic fascia is a meshwork of connective tissue and smooth muscle which connects the pelvic viscera to the pelvic side walls. It also serves as a conduit for blood vessels and nerves.The fascial planes enable skilled surgeons relatively bloodless access to the pelvic organs and pelvic floor
4 The Space of Retzius (Prevesical space) Is entered by perforating the transversalis fascialower boundary: Levator ani and pubic boneupper boundary: rectus abdominisLateral boundary: levator ani, and obturator internus fascia and the Arcus tendineus fascia pelvis.ContentsPlexus of SantoriniBladder and urethraObturator canal(watch for obturator branch of external iliac)
5 Vesicovaginal or Vesicouterine space Lower boundary: proximal third of the urethraUpper boundary: anterior cul-de-sacLateral boundary: pelvic side wall and broad and cardinal ligamentsPosterior boundary: uterus and vaginaAnterior boundary: Bladder and proximal urethraContentsUreters!!!!
6 Rectovaginal Space Distal boundary: perineal body Upper boundary: Posterior Cul-de –sacLateral boundaries: fascia of the levator ani and uterosacral ligamentsFloor : Coccygeus muscleAnterior boundary: vaginal muscularisPosterior boundary: rectal muscularisContentsRectal pillarsSacrospinous ligamentsUtero sacral ligaments
7 Retrorectal Space (pre sacral space) Upper border: bifurcation of the aortaLower border: sacrumLateral border: internal iliac arteriesContentsMiddle sacral vesselsLateral sacral vesselsPresacral nerves
8 Bilateral Paravesical Spaces Lower border: fascia of the levator AniMedial border: Obliterated Hypogastric arteryLateral border: external iliac arteryPosterior border: Broad ligamentAnterior border: Pubic symphysisContentsHypogastric arteryUreter
10 Caution Hazardous areas !!! Prevesical space: injury to Plexus of Santorini, obturatorvessels or nerve (Corona mortis)Vesicovaginal space: injury to the bladder or urethraRectovaginal space: damage to the rectosigmoid,Retro rectal space: injury to the aorta or common iliacs, middle orlateral sacral vessels, nerve plexus injuryParavesical spaces: injury to the bladder, or broad ligament externaliliac vessels (vein), obturator vessels or nerves, ureterPararectal spaces: injury to ureter, hypogastic vessels (vein)