2-6 Anatomy of the Pelvis: Membranes and Fascia

Question 1

What is the pelvic peritoneum?

Answer 1

1. Continuation of abdominal peritoneum into pelvis.

Question 2

What is the extent of the pelvic peritoneum?

Answer 2

2. Does not reach pelvic floor; draped over upper portions of pelvic viscera.

Question 3

What is the peritoneal covering of the bladder? The urethra?

Answer 3

The urinary bladder is peritonealized only on its superior surface; the urethra is subperitoneal (inferior to the peritoneum).

Question 4

How are the female reproductive organs peritonealized?

Answer 4

b. Female reproductive organs
1. Uterus, uterine tubes are peritonealized. The broad ligament is a thick, double layer of peritoneum extending from uterus to lateral pelvic walls.
2. The ovaries are suspended to the broad ligamented, but not actually invested with peritoneum.
3. The cervix and vagina are subperitoneal.

Question 5

How are the male reproductive organs peritonealized?

Answer 5

c. All male reproductive organs are subperitoneal.

Question 6

What is the peritonealization of the rectum?

Answer 6

d. Rectum: superior third is peritonealized anteriorly and laterally, middle third is peritonealized anterioly, inferior third is subperitoneal.

Question 7

How are peritoneal folds and fossa created?

Answer 7

4. Peritoneal folds and fossae (pouches) and created where the peritoneum sweeps over certain pelvic viscera.

Question 8

What are the 4 male peritoneal folds/fossa?

Answer 8

1. Supravesical fossa – between anterior body wall and bladder.
2. Paravesicle fossa – on either side of bladder
3. Rectovesical pouch – between bladder and rectum.
4. Pararectal fossa – on either side of lateral rectal wall; bounded laterally by sacrogenital folds (formed by thick ligaments underlying peritoneum; pass from base of bladder to sacrum).

Question 9

What are the 5 female peritoneal folds/fossa?

Answer 9

1. Supravesical fossa
2. Paravesicle fossa
3. Vesicouterine pouch – between bladder and uterus.
4. Rectouterine pouch (pouch of Douglas) – between uterus/vagina and rectum.
5. Pararectal fossa – on either side of lateral rectal wall; bounded laterally by uterosacral (rectouterine folds) (homologue of sacrogenital fold).

Question 10

How many layers make up membranous fascia?

Answer 10

2: parietal and visceral

Question 11

What does the parietal layer of membranous fascia cover?

Answer 11

1. Covers internal surface of pelvic wall and floor (forms obturator internus, piriformis, pelvic diaphragm fasciae).

Question 12

What makes up the tendinous arch of levator ani?

Answer 12

2. Obturator internus fascia is thickened along its horizontal midline to form the tendindous arch of levator ani.

Question 13

What does the visceral layer of membranous fascia cover?

Answer 13

pelvic viscera

Question 14

What makes up the tendinous arch of pelvic fascia? What are the anterior and posterior parts called?

Answer 14

2. Where pelvic organs pass through pelvic diaphragm, membranous fascia is thickened and forms the tendindous arch of pelvic fascia.
   a. Anterior part = puboprostatic (males) or pubovesical ligament (females).
   b. Posterior part = sacrogenital (uterosacral) ligaments.

Question 15

What is the endopelvic fascia?

Answer 15

a. Loose fascia filling space between parietal and visceral membranous fascias.

Question 16

What are the specializations of the endopelvic fascia?

Answer 16

1. Lateral ligament of bladder

2. Cardinal ligament (transverse cervical ligament) – conveys uterine vessels