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Anatomy Atlases: Atlas of Human Anatomy in Cross Section: Section 6: Pelvis, Perineum, Hip, and Upper Thigh

Atlas of Human Anatomy in Cross Section: Section 6. Pelvis, Perineum, Hip, and Upper Thigh

Plate 6.7

Ronald A. Bergman, Ph.D., Adel K. Afifi, M.D., Jean J. Jew, M.D., and Paul C. Reimann, B.S.
Peer Review Status: Externally Peer Reviewed

Plate 6.7

Upper Left Quadrant

Lower Left Quadrant

Lower Right Quadrant

Upper Right Quadrant

1. Median umbilical ligament
2. Sigmoid colon
3. Inferior epigastric a. and v.
4. Sigmoid colon
5. Vermiform appendix
6. External iliac Iymph node
7. Superficial epigastric a. and v.
8. Sartorius m. (first appearance)
9. Anterior inferior iliac spine
10. Tensor fascia lata m.
11. Iliofemoral ligament and superior gluteal vessels
12. Peritoneum and epiploic appendage
13. Obturator nerve

14. Superior gluteal neurovascular bundle
15. Superficial fascia
16. Os ilium at greater sciatic notch
17. Superior gluteal v. traversing greater sciatic foramen and peroneal nerve
18. Internal iliac a. and w.
19. Piriformis m. and tibial nerve
20. Sigmoid aa. and w.
21. Second sacral nerve
22. Sigmoid colon
23. Thoracolumbar fascia
24. Sacrum

25. Anterior sacral plexus of w.
26. Pelvic fascia
27. Second sacral nerve
28. Ala of sacrum
29. First and second sacral nerves
30. Piriformis m.
31. Superior gluteal a. and v.
32. Superior gluteal a. and v. traversing greater sciatic foramen
33. Gluteus maximus m.
34. Os ilium at greater sciatic notch
35. Ureter
36. Superior gluteal neurovascular bundle
37. Obturator internus m. (first appearance)

38. Os ilium
39. Gluteus medius m.
40. Obturator nerve
41. Gluteus minimus m.
42. Iliacus m.
43. Psoas major m.
44. Internal oblique and transversus abdominis mm.
45. External iliac a. and v.
46. Testicular a. and v.
47. Rectus (abdominis) sheath
48. Peritoneal cavity
49. Colon
50. Urinary bladder
51. Rectus abdominis m.
52. Pyramidalis m.

This section passes through the fourth sacral vertebra and sacral hiatus and the os ilium (38) at the sciatic notch (34).

The superior gluteal artery and vein (17, 32) can be seen traversing the greater sciatic foramen after supplying iliacus (42), piriformis (19, 30), and obturator internus (37) muscles and a nutrient artery to the ilium. Note the anterior sacral plexus of veins (25), which arise from the lateral sacral veins (which ultimately join the superior gluteal or internal iliac veins) and the median sacral vein. The median sacral vein communicates with the lateral sacral veins and with the anterior sacral plexus. These veins anastomose freely with neighboring lumbar, pelvic, and rectal veins. None of the veins have valves, hence they form a free communication between the systematic (caval) and portal systems of veins.

The obturator internus muscle (37) makes its first appearance in this cut.

The relationship between the peroneal (17) and tibial (19) nerves and piriformis muscle (19) is shown. The nerve to piriformis arises from the second or first and second sacral nerves, which contribute to the tibial nerve. The sciatic nerve is formed by the peroneal and tibial nerves within a common sheath that leaves the pelvis via the greater sciatic foremen, usually below the piriformis muscle.

Note the vermiform appendix (5) and its "mesentery." The appendix does not have a true mesentery; however, in about 90% of cases it is provided with a falciform fold of peritoneum, the mesoappendix, which is continuous with the dorsal (original left) surface of the mesentery of the ileum. In or near the free margin of the fold, the artery of the appendix, which is usually a branch of the ileocolic artery, may be found. The artery may also arise from the ileal, posterior cecal, or anterior cecal branch of the ileocecal artery. It usually passes dorsal to the ileum to enter the free border of the mesenteriolum of the appendix. The vessel may be doubled and it may also pass ventral to the ileum to supply the appendix.

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