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PELVIS & PERINEUM CLINICAL CORRELATIONS | 3BCACAO | CIONELO | GONZALES | ICARO | JIMENEZ | SARILE | TARROBAL | TENORIO

BONY PELVIS VS PELVIC GIRDLEBONY PELVIS PELVIC GIRDLE

- Composed of four bones namely the sacrum,coccyx and two innominate bones (fusion of the

ilium, ischium and pubis) - Joined by sacroiliac synchondroses to the sacrum

and to one another at the symphysis pubis

- Contains the coxial bone containing the ischium,pubis and their relative components

- The pelvis contains both coxal bone componentsand sacrum and coccyx

- Serves as an attachment of the lower limbs to theaxial skeleton

BOUNDARIES OF PELVIC INLET AND PELVIC OUTLETPELVIC INLET PELVIC OUTLET

ANTERIOR: Pubic Crest of Pubic Symphysis

POSTERIOR: anterior margin of the base of the sacrum (orthe Ala of thesacrum) and sacrovertebral angle (or sacralpromontory)

LATERAL: iliopectineal line (Arcuate line + Pecten Pubis)

ANTERIOR: Pubic Arch

LATERAL: Ischial TuberositiesPOSTEROLATERAL: inferior margin of the sacrotuberousligament

POSTERIOR: tip of the Coccyx

FALSE PELVIS VS TRUE PELVISFALSE PELVIS TRUE PELVIS

- Aka Greater Pelvis - Expanded portion above and in front of pelvic brim

- Above the pelvic inlet

-

has ilia on the side - incomplete in the front, with a wide intervalbetween anterior borders of ilia

- bounded by vertebra posteriorly - supports abdominal contents

- after first trimester, supports gravid uterus (infemales)

- aka Lesser Pelvis- below and behind the pelvic brim

- between the pelvic inlet and pelvic outlet

- bones are more complete compared to false pelvis- bounded by ischium and pubis, laterally and

anteriorly- bounded by sacrum and coccyx posteriorly

- internal borders are solid and immobile- posterior wall is twice the anterior wall

PELVIMETRY- the process of measuring the dimensions and capacity of the pelvis, especially of the adult female pelvis

- the diameter of the osseous birth canal are compared with that of the infant’s head to determine whether the

pelvis is of sufficient diameter to allow normal vaginal delivery - used in leading the decision of natural, operative vaginal delivery or conducting a Caesarean section

PERINEUM- area of tissue that marks externally the

approximate boundary of the outlet of the pelvisand gives passage to the urogenital ducts and

rectum - area between the anus and the posterior part of

the external genitalia - diamond shaped region demarcated by four

angles: anteriorly by the symphysis pubis,posteriorly by the tip of the coccyx and laterally by

the two ischial tuberosities - divided into two triangles by a line joining the two

ischial tuberosities, these are the urogenitaltriangle anteriorly and anorectal triangle

posteriorly

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BORDERS OF THE UROGENITAL AND ANAL TRIANGLEUROGENITAL TRIANGLE ANAL TRIANGLEANTERIORLY – Pubic Symphysis

POSTERIORLY – line joining the ischial tuberosities andperineal body

LATERALLY – Pubic Arch

ANTERIORLY - Perineal membrabePOSTEROLATERALLY – Sacrotuberous membrabe

PERINEAL BODY- central tendon of the perineum- pyramidal fibromuscular mass situated in the middle of the junction of urogenital triangle and anal triangle- In males, it is found between the bulb of the penis and the anus, while in females, it is found between the vagina andthe anus.

- essential for the integrity of the pelvic floor, especially in females. It provides attachment to the following muscles:- External anal sphincter muscle- Bulbospongiosus muscle- Superficial transverse perineal muscle- Levator ani muscle (anterior fibers)- External urinary sphincter- Deep transverse perineal muscle

ANORECTAL FISTULA AND GOODSALL’S RULEAnorectal Fistula

- Also known as fistula-in-ano , this is an abnormalcommunication between the anus and the perianalskin, thus creating a passageway for spread ofinfection from the surrounding anal glands into theintramuscular spaces. It can occur spontaneously,or secondary to perianal or perirectal abscess. Itmay also be secondary to trauma, Crohn’s disease,anal fissures, carcinoma, radiation therapy,actinomycoses, or chlamydial infections.

Types1. Transsphincteric fistulae are the result of

ischiorectal abscesses, with extension of the tractthrough the external sphincter. Account for about25% of all fistulae.

2. Intersphincteric fistulae are confined to theintersphincteric space and internal sphincter. Theyresult from perianal abscesses. Account for about70% of all fistulae.

3. Suprasphincteric fistulae are the result of

supralevator abscesses. They pass through thelevator ani muscle, over the top of thepuborectalis muscle, and into the intersphinctericspace. Account for about 5% of all fistulae.

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