Pampiniform plexus

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Pampiniform plexus
Gray1147.png
Spermatic veins
Details
Drains from Testicle, epididymis
Drains to Testicular vein
Identifiers
Latin plexus venosus pampiniformis, plexus pampiniformis
TA98 A12.3.09.015
TA2 5016, 5019
FMA 19607
Anatomical terminology

The pampiniform plexus (from Latin pampinus 'tendril'and forma 'form') is a venous plexus – a network of many small veins found in the human male spermatic cord, and the suspensory ligament of the ovary. In the male, it is formed by the union of multiple testicular veins from the back of the testis and tributaries from the epididymis.

Contents

In the male

The veins of the plexus ascend along the spermatic cord in front of the vas deferens. Below the superficial inguinal ring they unite to form three or four veins, which pass along the inguinal canal, and, entering the abdomen through the deep inguinal ring, coalesce to form two veins. These again unite to form a single vein, the testicular vein, which opens on the right side into the inferior vena cava, at an acute angle, and on the left side into the left renal vein, at a right angle. The pampiniform plexus forms the chief mass of the cord.

In addition to its function in venous return from the testes, the pampiniform plexus also plays a role in the temperature regulation of the testes. It acts as a countercurrent heat exchanger, cooling blood in adjacent arteries. An abnormal enlargement of the pampiniform plexus is a medical condition called varicocele.

In the female

In females, the pampiniform plexus drains the ovaries. The right ovary drains to the pampiniform plexus to the ovarian vein to the inferior vena cava. The left ovary drains to the pampiniform plexus, left ovarian vein, then the left renal vein, to the inferior vena cava. [1]

While varicocele is the diagnostic term for swelling in the valveless venous distribution of the male pampiniform plexus, this embryological structure, common to males and females, is often incidentally noted to be swollen during laproscopic examinations in both symptomatic and asymptomatic females. [2] Diagnosis of female varicocele, properly called pelvic compression syndrome, should be expected to be as frequent as male varicocele (15% of healthy asymptomatic men which are thought to develop primarily during puberty and prevalence increases approximately 10% per decade of life [3] ).

While one may expect that the female to have equal prevalence of pelvic compression syndrome due to the identical embryological origin of the valveless pampiniform plexus, this condition is thought to be underdiagnosed due to the broad differential of the pain pattern: unilateral or bilateral pain, dull to sharp, constant to intermittent pain worsening with any increase in abdominal pressure.

Physical exam has specificity of 77% and sensitivity of nearly 94% when the patient is noted to be tender over adnexa during physical examination with a history of postcoital pain for differentiating pelvic congestion syndrome from other pathologies of pelvic origin. [4] Confirmatory imaging requires ultrasound while performing the Valsalva maneuver, while the gold standard remains ovarian and iliac catheter venography showing veins 5–10 mm in diameter during Valsalva.

Clinical significance

Damage to the plexus during inguinal hernia repair is the chief cause of ischaemic orchitis following this surgery; such orchitics typically presents within a week post-surgery and is almost always self-limiting. Its incidence is <1% for primary hernia repair, but more for recurrent hernia repairs. [5]

See also

Related Research Articles

<span class="mw-page-title-main">Inferior vena cava</span> One of two veinous trunks bringing deoxygenated blood back to the heart

The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra.

<span class="mw-page-title-main">Spermatic cord</span> Structure in the human male reproductive system

The spermatic cord is the cord-like structure in males formed by the vas deferens and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis, is an extension of the peritoneum that passes through the transversalis fascia. Each testicle develops in the lower thoracic and upper lumbar region and migrates into the scrotum. During its descent it carries along with it the vas deferens, its vessels, nerves etc. There is one on each side.

<span class="mw-page-title-main">Inguinal canal</span> Human abdominal anatomy

The inguinal canal is a passage in the anterior abdominal wall on each side of the body, which in males, convey the spermatic cords and in females, the round ligament of the uterus. The inguinal canals are larger and more prominent in males.

<span class="mw-page-title-main">Inguinal hernia</span> Protrusion of abdominal contents through the inguinal canal in the pelvis

An inguinal hernia or groin hernia is a hernia (protrusion) of abdominal cavity contents through the inguinal canal. Symptoms, which may include pain or discomfort especially with or following coughing, exercise, or bowel movements, are absent in about a third of patients. Symptoms often get worse throughout the day and improve when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.

<span class="mw-page-title-main">Varicocele</span> Abnormal enlargement of the pampiniform plexus veins in the genitals

A varicocele is, in a man, an abnormal enlargement of the pampiniform venous plexus in the scrotum; in a woman, it is an abnormal painful swelling to the embryologically identical pampiniform venous plexus; it is more commonly called pelvic compression syndrome. In the male varicocele, this plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Varicoceles occur in around 15% to 20% of all men. The incidence of varicocele increase with age.

<span class="mw-page-title-main">External iliac vein</span> Blood vessels connecting the thigh veins to the pelvis

The external iliac veins are large veins that connect the femoral veins to the common iliac veins. Their origin is at the inferior margin of the inguinal ligaments and they terminate when they join the internal iliac veins.

<span class="mw-page-title-main">Hepatic veins</span> One of two sets of veins connected to the liver

In human anatomy, the hepatic veins are the veins that drain venous blood from the liver into the inferior vena cava. There are usually three large upper hepatic veins draining from the left, middle, and right parts of the liver, as well as a number (6-20) of lower hepatic veins. All hepatic veins are valveless.

<span class="mw-page-title-main">Inferior epigastric artery</span> Blood vessel

In human anatomy, the inferior epigastric artery is an artery that arises from the external iliac artery. It is accompanied by the inferior epigastric vein; inferiorly, these two inferior epigastric vessels together travel within the lateral umbilical fold The inferior epigastric artery then traverses the arcuate line of rectus sheath to enter the rectus sheath, then anastomoses with the superior epigastric artery within the rectus sheath.

<span class="mw-page-title-main">Nutcracker syndrome</span> Compression of the left renal vein, restricting bloodflow from the left kidney

The nutcracker syndrome (NCS) results most commonly from the compression of the left renal vein (LRV) between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA appear to be a nutcracker crushing a nut.

<span class="mw-page-title-main">Gonadal vein</span> Blood vessel carrying blood away from the testis or ovaries

In medicine, gonadal vein refers to the blood vessel that carries blood away from the gonad toward the heart. These are different arteries in women and men, but share the same embryological origin.

<span class="mw-page-title-main">Renal plexus</span> Nerve in the abdominal region

The renal plexus is a complex network of nerves formed by filaments from the celiac ganglia and plexus, aorticorenal ganglia, lower thoracic splanchnic nerves and first lumbar splanchnic nerve and aortic plexus.

<span class="mw-page-title-main">Abdominal aortic plexus</span>

The abdominal aortic plexus is formed by branches derived, on either side, from the celiac plexus and ganglia, and receives filaments from some of the lumbar ganglia.

<span class="mw-page-title-main">Testicular artery</span> Branch of the abdominal aorta that supplies blood to the testicle

The testicular artery is a branch of the abdominal aorta that supplies blood to the testicle. It is a paired artery, with one for each of the testicles.

<span class="mw-page-title-main">Ovarian vein</span> Blood vessel which drains one of the ovaries

The ovarian vein, the female gonadal vein, carries deoxygenated blood from its corresponding ovary to inferior vena cava or one of its tributaries. It is the female equivalent of the testicular vein, and is the venous counterpart of the ovarian artery. It can be found in the suspensory ligament of the ovary.

<span class="mw-page-title-main">Testicular vein</span> Blood vessel which drains one of the testicles

The testicular vein, the male gonadal vein, carries deoxygenated blood from its corresponding testis to the inferior vena cava or one of its tributaries. It is the male equivalent of the ovarian vein, and is the venous counterpart of the testicular artery.

<span class="mw-page-title-main">Ovarian vein syndrome</span> Pinching of the ureter due to widening of the ovarian vein

Ovarian vein syndrome is a rare condition in which dilation of the ovarian vein compresses the ureter. This causes chronic or colicky abdominal pain, back pain and/or pelvic pain. The pain can worsen on lying down or between ovulation and menstruation. There can also be an increased tendency towards urinary tract infection or pyelonephritis. The right ovarian vein is most commonly involved, although the disease can be left-sided or affect both sides. It is currently classified as a form of pelvic congestion syndrome.

<span class="mw-page-title-main">Pelvic congestion syndrome</span> Medical condition

Pelvic congestion syndrome, also known as pelvic vein incompetence, is a long-term condition believed to be due to enlarged veins in the lower abdomen. The condition may cause chronic pain, such as a constant dull ache, which can be worsened by standing or sex. Pain in the legs or lower back may also occur.

<span class="mw-page-title-main">Scrotal ultrasound</span> Medical ultrasound examination of the scrotum.

Scrotalultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development, and is normally a component of an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam can also be conducted to verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to not being circumcised, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues, and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using imaging or ultrasounds will be needed for further evaluation.

Pelvic compression syndrome is characterized by intermittent or persisting pain in the abdomen, which is exacerbated by abdominal pressure. A swelling of the veins in the valveless pampiniform plexus causes it.

References

PD-icon.svgThis article incorporates text in the public domain from page 1240 of the 20th edition of Gray's Anatomy (1918)

  1. Le, Tao; Bhushan, Vikas (2013). First Aid for the USMLE Step 1 2013. McGraw Hill Professional. ISBN   978-0-07-180233-8.[ page needed ]
  2. Tu, Frank F.; Hahn, David; Steege, John F. (May 2010). "Pelvic Congestion Syndrome-Associated Pelvic Pain: A Systematic Review of Diagnosis and Management". Obstetrical & Gynecological Survey. 65 (5): 332–340. doi:10.1097/OGX.0b013e3181e0976f. PMID   20591203. S2CID   27110647.
  3. Alsaikhan, Bader; Alrabeeah, Khalid; Delouya, Guila; Zini, Armand (2016). "Epidemiology of varicocele". Asian Journal of Andrology. 18 (2): 179–181. doi: 10.4103/1008-682X.172640 . PMC   4770482 . PMID   26763551.
  4. O'Brien, Marlene T.; Gillespie, David L. (January 2015). "Diagnosis and treatment of the pelvic congestion syndrome". Journal of Vascular Surgery: Venous and Lymphatic Disorders. 3 (1): 96–106. doi:10.1016/j.jvsv.2014.05.007. PMID   26993690.
  5. Schwartz's Principles of Surgery (11th ed.). 2019. p. 1620.