Superior hypogastric plexus

Last updated
Superior hypogastric plexus
Gray838.png
The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses. (Hypogastric plexus is labeled on right, fourth from the bottom.)
Gray849.png
Lower half of right sympathetic cord.
Details
Innervates Pelvis
Identifiers
Latin plexus hypogastricus superior, nervus presacralis
MeSH D007001
TA98 A14.3.03.046
TA2 6711
FMA 6642
Anatomical terms of neuroanatomy

The superior hypogastric plexus (in older texts, hypogastric plexus or presacral nerve) is a plexus of nerves situated on the vertebral bodies anterior to the bifurcation of the abdominal aorta. It bifurcates to form the left and the right hypogastric nerve. [1] The SHP is the continuation of the abdominal aortic plexus. [2]

Contents

Structure

Afferents

The superior hypogastric plexus receives contributions from the two lower lumbar splanchnic nerves (L3-L4), which are branches of the chain ganglia. They also contain parasympathetic fibers which arise from pelvic splanchnic nerve (S2-S4) and ascend from inferior hypogastric plexus; it is more usual for these parasympathetic fibers to ascend to the left-handed side of the superior hypogastric plexus and cross the branches of the sigmoid and left colic vessel branches, as these parasympathetic branches are distributed along the branches of the inferior mesenteric artery. [2]

Efferents

From the plexus, sympathetic fibers are carried into the pelvis as two main trunks - the right and left hypogastric nerves - each lying medial to the internal iliac artery and its branches. The right and left hypogastric nerves continues as inferior hypogastric plexus; these hypogastric nerves send sympathetic fibers to the ovarian and ureteric plexuses, which originate within the renal and abdominal aortic sympathetic plexuses. [2]

Relations

The superior hypogastric plexus is often displaced somewhat to the left of the midline. It is situated between the common iliac arteries. It is anterior to the lumbar vertebra L5 and sacral promontory, the aortic bifurcation, and left common iliac vein. It is posterior to the parietal peritoneum (with avascular areolar tissue intervening between these two structures). It is situated near the apex of the attachment of the sigmoid mesocolon. [3]

Clinical significance

Presacral neurectomy is a laparoscopic procedure where superior hypogastric plexus is excised, so that the pain pathway is cut off from the spinal column. This procedure is done to manage chronic pelvic pain when conservative medical therapy fails. [1]

Additional images

Related Research Articles

<span class="mw-page-title-main">Sigmoid colon</span> Section of the large intestine closest to the rectum and anus

The sigmoid colon is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 35–40 centimetres (14–16 in) in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S. This part of the colon normally lies within the pelvis, but due to its freedom of movement it is liable to be displaced into the abdominal cavity.

<span class="mw-page-title-main">Abdominal aorta</span> Largest artery in the abdomen

In human anatomy, the abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

<span class="mw-page-title-main">External iliac artery</span> Arteries of the pelvis

The external iliac arteries are two major arteries which bifurcate off the common iliac arteries anterior to the sacroiliac joint of the pelvis.

<span class="mw-page-title-main">Common iliac artery</span> Artery in the abdomen

The common iliac artery is a large artery of the abdomen paired on each side. It originates from the aortic bifurcation at the level of the 4th lumbar vertebra. It ends in front of the sacroiliac joint, one on either side, and each bifurcates into the external and internal iliac arteries.

<span class="mw-page-title-main">Nerve plexus</span> Network of nerve fibres

A nerve plexus is a plexus of intersecting nerves. A nerve plexus is composed of afferent and efferent fibers that arise from the merging of the anterior rami of spinal nerves and blood vessels. There are five spinal nerve plexuses, except in the thoracic region, as well as other forms of autonomic plexuses, many of which are a part of the enteric nervous system. The nerves that arise from the plexuses have both sensory and motor functions. These functions include muscle contraction, the maintenance of body coordination and control, and the reaction to sensations such as heat, cold, pain, and pressure. There are several plexuses in the body, including:

<span class="mw-page-title-main">Sacral plexus</span> Nerve plexus

In human anatomy, the sacral plexus is a nerve plexus which provides motor and sensory nerves for the posterior thigh, most of the lower leg and foot, and part of the pelvis. It is part of the lumbosacral plexus and emerges from the lumbar vertebrae and sacral vertebrae (L4-S4). A sacral plexopathy is a disorder affecting the nerves of the sacral plexus, usually caused by trauma, nerve compression, vascular disease, or infection. Symptoms may include pain, loss of motor control, and sensory deficits.

<span class="mw-page-title-main">Internal iliac artery</span> Main artery of the pelvis

The internal iliac artery is the main artery of the pelvis.

<span class="mw-page-title-main">Lumbar plexus</span> Web of nerves in the lower spine

The lumbar plexus is a web of nerves in the lumbar region of the body which forms part of the larger lumbosacral plexus. It is formed by the divisions of the first four lumbar nerves (L1-L4) and from contributions of the subcostal nerve (T12), which is the last thoracic nerve. Additionally, the ventral rami of the fourth lumbar nerve pass communicating branches, the lumbosacral trunk, to the sacral plexus. The nerves of the lumbar plexus pass in front of the hip joint and mainly support the anterior part of the thigh.

<span class="mw-page-title-main">Cardiac plexus</span> Bunch of vagus nerve branches that support the hearts functions

The cardiac plexus is a plexus of nerves situated at the base of the heart that innervates the heart.

<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">Pelvic cavity</span> Body cavity bounded by the pelvic bones

The pelvic cavity is a body cavity that is bounded by the bones of the pelvis. Its oblique roof is the pelvic inlet. Its lower boundary is the pelvic floor.

<span class="mw-page-title-main">Inferior hypogastric plexus</span>

The inferior hypogastric plexus is a network of nerves that supplies the organs of the pelvic cavity. The inferior hypogastric plexus gives rise to the prostatic plexus in males and the uterovaginal plexus in females.

Pelvic splanchnic nerves or nervi erigentes are splanchnic nerves that arise from sacral spinal nerves S2, S3, S4 to provide parasympathetic innervation to the organs of the pelvic cavity.

<span class="mw-page-title-main">Sacral splanchnic nerves</span>

Sacral splanchnic nerves are splanchnic nerves that connect the inferior hypogastric plexus to the sympathetic trunk in the pelvis.

The lumbar splanchnic nerves are splanchnic nerves that arise from the lumbar ganglia and travel to an adjacent plexus near the aorta. They originate from L1 and L2. Together with fibres from the aortic plexus, they form the superior hypogastric plexus.

<span class="mw-page-title-main">Hypogastric nerve</span> Human nerves

The hypogastric nerves are the continuation of the superior hypogastric plexus that descend into the pelvis anterior the sacrum and become the inferior hypogastric plexuses on either side of pelvic organs. The hypogastric nerves serve as a pathway for autonomic fibers to communicate between the lower abdomen and pelvis.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

<span class="mw-page-title-main">Aortic bifurcation</span>

The aortic bifurcation is the point at which the abdominal aorta bifurcates (forks) into the left and right common iliac arteries. The aortic bifurcation is usually seen at the level of L4, just above the junction of the left and right common iliac veins.

<span class="mw-page-title-main">Outline of the human nervous system</span> Overview of and topical guide to the human nervous system

The following diagram is provided as an overview of and topical guide to the human nervous system:

References

  1. 1 2 Chen, FP (January 2000). "Laparoscopic presacral neurectomy for chronic pelvic pain". Chang Gung Medical Journal. 23 (1): 1–7. PMID   10746403.
  2. 1 2 3 Eid S, Iwanaga J, Chapman JR, Oskouian RJ, Loukas M, Tubbs RS (2018). "Superior Hypogastric Plexus and Its Surgical Implications During Spine Surgery: A Review". World Neurosurg. 120: 163–167. doi:10.1016/j.wneu.2018.08.170. PMID   30172971. S2CID   52145526.
  3. Sinnatamby, Chummy (2011). Last's Anatomy (12th ed.). p. 281. ISBN   978-0-7295-3752-0.

PD-icon.svgThis article incorporates text in the public domain from page 987 of the 20th edition of Gray's Anatomy (1918)