Ovary (Ovarium)
The ovary (Ovarium) is located laterally in the pelvic region and runs in a vertical orientation. It has an inner surface facing the pelvic interior (Facies medialis/intestinalis) and an outer surface directed towards the lateral pelvic wall (Facies lateralis). The rounded free edge is called the Margo liber, and at the anterior edge, the Margo mesovaricus, the mesovarium is attached, which is a structure of the broad ligament of the uterus (Lig. latum uteri).
There are two poles:
- Uterine extremity
- Tubal extremity
The hilum of the ovary, where vessels and nerves enter, is located at the attachment of the connective tissue of the ovary, known as the mesovarium, at the Margo mesovaricus.
The ovary is connected to the pelvic wall at the tubal extremity by the suspensory ligament of the ovary. The ovarian vessels (Vasa ovarica), lymphatic vessels, and nerves run along this suspensory ligament.
The proper ovarian ligament lies between the ovary (uterine extremity). This is located directly behind the tubal angle. The artery R. ovaricus of the uterine artery runs here.
The ovary is supplied by:
- Ovarian artery
- Ovarian branch from the uterine artery.
These arteries form anastomoses at the Margo mesovaricus and supply the ovary with blood.
Veins transport the venous blood via the right ovarian vein to the inferior vena cava and via the left ovarian vein to the left renal vein. Part of the blood flows through the uterine plexus to the internal iliac vein.
The ovary is located in the abdominal cavity (intraperitoneal) in the ovarian fossa. Here, in the retroperitoneum, run the obturator nerve, obturator vessels, and the external iliac vessels. Medially, the umbilical artery and the uterine artery also run.
The Fallopian Tube (Tuba uterina, Salpinx)
The Fallopian tube, also known as the Tuba uterina, is about 10-15 centimeters long and 2-5 millimeters thick. It runs intraperitoneally along the upper free edge of the broad ligament of the uterus (Ligamentum latum uteri), from the corner of the uterus to the ovary. In the mesosalpinx, the blood vessels and nerves to the Fallopian tube run, additionally anchoring the tube to the broad ligament.
The Fallopian tube itself can be divided into different sections:
- Infundibulum of the Fallopian tube (+ abdominal ostium of the Fallopian tube)
- Fimbriae of the Fallopian tube,
- Ampulla of the Fallopian tube
- Isthmus of the Fallopian tube
- Uterine part.
The blood supply of the Fallopian tube is provided by small branches (Rr. tubarii) from the ovarian and uterine arteries, which run in the mesosalpinx and anastomose with each other. Veins accompany the arteries and drain into the ovarian vein and the uterine/uterovaginal plexus.
The Uterus
The uterus, also called the womb, is a hollow, muscular organ in the female body that plays an important role during pregnancy and childbirth.
The uterus consists of:
- the body (Corpus uteri),
- the isthmus uteri
- the cervix (Cervix uteri)
The average length of the uterus is about 7.5 cm, the width 4 cm, and the thickness 2.5 cm.
The fundus: uteri represents the upper section of the uterus, located above the entry points of the Fallopian tubes. Its lateral walls are connected to the broad ligament of the uterus (Ligamentum latum uteri). At the lateral edges of the uterus, where the Fallopian tubes enter the uterus, the tubal angle is formed. From the tubal angle, the proper ovarian ligament extends to the ovary, while the round ligament of the uterus extends to the inguinal canal.
Cervix uteri: The cervix extends with its conical lower third into the vagina. It is divided into the supravaginal portion of the cervix (Endocervix) and the vaginal portion of the cervix (Ectocervix or simply Portio). In the upper area of the vagina, the cervix uteri forms the anterior and posterior vaginal fornices (Fornix vaginae) between the Portio and the vaginal wall.
Vaginal portion: At the end of the vaginal portion is the external os, also known as the external orifice of the uterus (Ostium uteri or Orificium externum uteri).
The vaginal portion is usually reddish in color and is covered with stratified, non-keratinized squamous epithelium, similar to the vagina. At the transition to the Ostium uteri, this epithelium changes to the single-layered, columnar epithelium of the cervical canal (Canalis cervicis). Between puberty and menopause, the cylindrical epithelium of the cervical canal can migrate outward onto the Portio (ectropion), leading to more intense redness. With a colposcopy, precancerous stages and cancer can be detected in this area.
Rectum:
- Origin of the rectum: Extension of the sigmoid colon, beginning at the upper edge of the third sacral vertebra.
- Shape and curves:
- Sacral flexure: Follows the contour of the sacrum downward.
- Anorectal (perineal) flexure: Bends backward in the area of the perineum, bulging forward.
- Lateral flexures: Occasionally variable curves in the frontal plane.
- Structural features:
- Length of about 15 cm.
- Three semilunar transverse folds; the most prominent is the Kohlrausch fold about 6 cm above the anus on the right side.
- Continuation into the anal canal: Ampulla recti above the anal canal, which expands when filled.
- Boundaries and location:
- Upper section: Covered by peritoneum in front and laterally, retroperitoneal (Rectum fixum).
- Peritoneal contact: In women, the peritoneum meets the posterior vaginal fornix and the back of the uterus (Rectouterine pouch) at the middle transverse fold.
- Below the Kohlrausch fold: Completely extraperitoneal.
- Anatomical neighborhood:
- Adjacent posteriorly to the sacrum, coccyx, and the posterior parts of the levator ani muscle.
- Adjacent anteriorly to the vagina.
- Vascularization and innervation:
- Median sacral artery, superior rectal artery.
- Sympathetic trunks, lateral sacral arteries, sacral plexus in retrorectal connective tissue.
Urinary Bladder:
The urinary bladder is a muscular hollow organ that serves to store urine and later expel it through the urethra. The bladder's capacity is normally 300-500 ml. The bladder can be divided into different parts,
- the apex of the bladder (Apex vesicae),
- the body of the bladder (Corpus vesicae),
- the base of the bladder (Fundus vesicae),
- the neck of the bladder (Collum or Cervix vesicae), transition to the urethra
The apex is connected to the median umbilical ligament (Chorda urachi), the obliterated allantoic duct, which leads to the navel.
The peritoneum extends from the bladder to the uterus (Vesicouterine pouch).
The trigone of the bladder is a roughly triangular, smooth mucosal area located at the base of the bladder. This triangle is formed by the two openings of the ureters (Ostia ureterum) and the internal opening of the urethra (Ostium urethrae internum). The interureteric fold bounds the trigone posteriorly, and anteriorly a corner is formed, which extends into the urethra. In this area, the mucosa is closely fused with the muscularis. In the rest of the bladder, there is a submucosa, which forms a flexible buffer zone between the mucosa and muscle layer, allowing the bladder to fill and empty easily.
Douglas Pouch:
The peritoneum, also known as the peritoneal membrane, forms a kind of double layer in the pelvic area of the woman, covering and protecting the internal organs.
The peritoneum lies like a cloth over the uterus. Anteriorly, it covers the bladder and the anterior wall of the uterus, forming a depression at the level of the cervix uteri, called the vesicouterine pouch. It further extends over the fundus and onto the posterior wall to the posterior vaginal fornix. Here, another depression is formed, known as the rectouterine pouch or Douglas pouch. The peritoneum then covers the anterior wall of the rectum. The Douglas pouch is the deepest point in the female pelvis.
