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Avascular Spaces of the Pelvis

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Presentation on theme: "Avascular Spaces of the Pelvis"— Presentation transcript:

1 Avascular Spaces of the Pelvis
(Where the blood vessels are not!!!)

2 Avascular Spaces Potential spaces—filled with fat and connective tissue Eight 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 space Each pelvic organ can be separated from the others by opening avascular spaces.

3 Endopelvic Fascia The 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 fascia lower boundary: Levator ani and pubic bone upper boundary: rectus abdominis Lateral boundary: levator ani, and obturator internus fascia and the Arcus tendineus fascia pelvis. Contents Plexus of Santorini Bladder and urethra Obturator canal(watch for obturator branch of external iliac)

5 Vesicovaginal or Vesicouterine space
Lower boundary: proximal third of the urethra Upper boundary: anterior cul-de-sac Lateral boundary: pelvic side wall and broad and cardinal ligaments Posterior boundary: uterus and vagina Anterior boundary: Bladder and proximal urethra Contents Ureters!!!!

6 Rectovaginal Space Distal boundary: perineal body
Upper boundary: Posterior Cul-de –sac Lateral boundaries: fascia of the levator ani and uterosacral ligaments Floor : Coccygeus muscle Anterior boundary: vaginal muscularis Posterior boundary: rectal muscularis Contents Rectal pillars Sacrospinous ligaments Utero sacral ligaments

7 Retrorectal Space (pre sacral space)
Upper border: bifurcation of the aorta Lower border: sacrum Lateral border: internal iliac arteries Contents Middle sacral vessels Lateral sacral vessels Presacral nerves

8 Bilateral Paravesical Spaces
Lower border: fascia of the levator Ani Medial border: Obliterated Hypogastric artery Lateral border: external iliac artery Posterior border: Broad ligament Anterior border: Pubic symphysis Contents Hypogastric artery Ureter

9 Bilateral Pararectal Spaces
Floor: coccygeus muscle Medial boundary: Ureter Lateral boundary: hypogastric artery Anterior boundary: broad ligament Posterior boundary: sacrum Contents Ureter Hypogastric artery

10 Caution Hazardous areas !!!
Prevesical space: injury to Plexus of Santorini, obturator vessels or nerve (Corona mortis) Vesicovaginal space: injury to the bladder or urethra Rectovaginal space: damage to the rectosigmoid, Retro rectal space: injury to the aorta or common iliacs, middle or lateral sacral vessels, nerve plexus injury Paravesical spaces: injury to the bladder, or broad ligament external iliac vessels (vein), obturator vessels or nerves, ureter Pararectal spaces: injury to ureter, hypogastic vessels (vein)

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