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Uteri.— In comparison with the size of the organ, the cavity of the small size owing to the great thickness of the uterine wall. In the body, is merely a narrow chink between the anterior and posterior walls, almost in contact (Fig. 1033). When, however, the uterus is opened > downwards in frontal section of the organ, the cavity of the body ular outline (Fig. 1032). The base of the triangle is directed upwards, and
to a line drawn between the openings of the uterine tubes, while the rected downwards towards the cervix. The sides of the triangle are vards towards the cavity. The cavity of the body becomes continuous of the cervix by an opening called the orificium internum uteri (O.T. : uteri), which is a little smaller and more circular than the external the uterus. The cavity of the cervix, canalis cervicis uteri, or cervical ends from the internal orifice of the uterus, where it joins the cavity of to the external orifice, where it opens into the vagina. It is a somewhat a ped passage, which is narrower above and below than in its middle part; how also that its antero-posterior diameter is shorter than its transverse g to an approximation of its anterior and posterior walls. In the body of
Ep-oophoron Tuba uterina
Cavity of body
Cavity of cervix
B 32.-A. THE POSTERIOR ASPECT OF THE UTERUS AND BROAD LIGAMENT (the broad ligament has
been spread out). dc, the isthmus tubæ, the ligament of the ovary, and the round ligament of the right side cut short. LAGRAMMATIC REPRESENTATION OF THE UTERINE CAVITY OPENED UP FROM ITS ANTERIOR ASPECT.
erus the walls of the cavity are smooth and even, but in the cervical canal the as membrane forms a remarkable series of folds, called the plicæ palmatæ (O.T. vitæ uteri). These consist of an anterior and a posterior longitudinally ed fold or ridge, from which a large number of secondary folds, or ruge, h off obliquely upwards and laterally (Fig. 1032, B). onnexions of the Uterus and its Relations to the Peritoneum.-- In addition
uterine tubes at its upper lateral angles, and the vagina below, the uterus Esses other important connexions. Some of these are simply peritoneal folds ng from the uterus to neighbouring structures; others contain fibrous conve tissue, or smooth muscle fibres. The peritoneum covering the fundus of the uterus is continued down over the cal surface as far as the junction of the body and cervix, where it leaves the us to be reflected on to the bladder, forming the utero-vesical fold, or “ anterior ment of the uterus.” The peritoneal recess between the bladder and the uterus alled the excavatio vesicouterina, or utero-vesical pouch. Below the level of pouch the anterior aspect of the cervix is connected by loose tissue with
posterior, or basal, part of the bladder. Posteriorly the peritoneum covers the ole of the uterus, except the small portion of the cervix which projects into
upper part of the vagina. The peritoneum covering the intestinal surface of 2 uterus is continued to such a depth that it invests a small portion of the upper rt of the posterior wall of the vagina before it is reflected on to the rectum, form the recto-vaginal fold (Fig. 1033). The deep pouch between the uterus and
vagina in front and the rectum behind is called the excavatio rectouterina, or rectouterine pouch of Douglas, and its entrance is bounded on each side by a crescentic peritoneal fold, which passes from the posterior surface of the cervix uteri to the posterior wall of the pelvis, and ends near the side of the rectum. These crescentie folds are called the plicæ rectouterinæ, or recto-uterine folds of Douglas, and each contains between its layers a considerable amount of fibrous and smooth muscular tissue. A few of these fibres, which are continuous with the uterine wall, pass backwards to reach the rectum and constitute the musculus rectouterinus; others are said to gain an attachment to the front of the sacrum, and form a utero-sacral ligament. În many cases the recto-uterine folds become continuous with one another across the median plane behind the cervix uteri, and form, in this position, a transverse ridge termed the torus uterinus. The recto-uterine pouch of the female represents the recto-vesical pouch of the male, and the folds which bound it on each side, namely, the recto-uterine folds, correspond to the sacro-genital folds (sometimes called posterior false ligaments of the bladder) in the male sex.
The peritoneum of the vesical and intestinal surfaces, leaving the uterus along each lateral border to reach the side wall of the pelvis, forms the broad ligament of the uterus.
The ligamentum latum uteri, or broad ligament, is a wide peritoneal fold which passes from the lateral border of the uterus to the pelvic wall, and contains between its layers several important structures (Fig. 1032). The plane of the medial part of the ligament is determined by the position of the uterus. When the uterus is normally placed, the ligament has an anterior surface which looks downwards as well as forwards, and a posterior one which looks upwards and backwards. Near its attachment to the pelvis the ligament is placed more vertically. The free edge of the ligament contains the uterine tube, and follows the course pursued by that structure. Thus, in the undisturbed condition of parts, it at first passes horizontally laterally towards the uterine extremity of the ovary, where it ascends to arch over the tubal pole of the ovary on its medial side. Owing to the course pursued by the uterine tube round the ovary, the broad ligament forms a kind of curtain over the gland, and the ovary lies in a little pocket formed by the broad ligament, to which the name of bursa ovarica is applied (Figs. 1028 and 1029). This bursa ovarica is not to be confused with the fossa ovarii, or depression on the side wall of the pelvis, against which the ovary is usually placed.
The various structures in connexion with the broad ligament are most easily demonstrated when the ligament is spread out as flat as possible.
The ovary is connected with the posterior layer of the broad ligament by a very short mesentery, called the mesovarium, which, passing to the hilum, encloses the ovarian vessels and nerves as they reach the ovary. The part of the broad ligament which slings the uterine tube is called the mesosalpinx. When the ligament is spread out, the mesosalpinx has the form of a narrow triangle, the apex of which is at the lateral angle of the uterus, while the upper side is formed by the uterine tube, and the inferior one by the ligament of the ovary and the ovary itself. The narrow base of the triangle is directed laterally. Between the layers of this part of the broad ligament are situated the ep-oöphoron (O.T. parovarium), and the par-oöphoron (Fig. 1032). The part of the broad sigament below the level of the mesosalpinx is termed the mesometrium, and contains, especially in its lower part, a considerable amount of fatty connective tissue, the parametrium, and unstriped muscle fibres. The ureter and the uterine vessels lie in the lowest part of the broad ligament where it joins the pelvic floor. The fibrous and smooth muscle tissue which lies in the lower part of the broad ligament, immediately below the uterine artery, forms what is known as the lateral cervical ligament of the
It is continuous with the dense tissue surrounding the branches of the hypogastric artery, and in vertical antero-posterior section has a triangular outline near its attachment to the cervix uteri.
The highest part of the attached lateral portion of the broad ligament forms the ligamentum suspensorium ovarii or suspensory ligament of the ovary, and contains between its layers the ovarian vessels and nerves as they enter or leave the pelvis.
The ligamentum ovarii proprium, or ligament of the orary, is a rounded fibrous
Position Ils in the houring Lace tha billy the
ut one inch in length, which is attached by its lateral end to the of the ovary, and by its medial end to the lateral angle of the uterus
below and behind the entrance of the uterine tube. This ligais largely composed of unstriped muscle fibres continuous with those is, is enclosed in a slight fold derived from the posterior layer of the ent. ent of the ovary represents the upper portion of the gubernaculum which appears
imentum teres uteri, or round ligament of the uterus, is a narrow flat ed to the uterus just in front of, and a little below, the opening of the
Near the uterus it contains numerous smooth muscle fibres, which 1ous with those of the uterus; more laterally it is composed chiefly of nective tissue. Lying in the anterior part of the broad ligament, it e wall of the pelvis minor, and is then directed forwards and slightly
cross the obliterated umbilical artery and the pelvic brim. After it has e pelvic wall its course is comparable to that of the ductus deferens in the like the latter, it leaves the abdomen to traverse the inguinal canal (Figs. 1029). It finally ends in the subcutaneous tissue and skin of the labium ts terminal part is composed of connective tissue only. cases a small diverticulum of the peritoneal cavity can be traced accompanying the nent through the abdominal wall. This is called the processus vaginalis peritonei of Nuck), and corresponds to the processus vaginalis of the male (p. 1294). und ligament of the uterus represents the lower portion of the gubernaculum testis ars in the male embryo (see pp. 1294 and 1313). ion and Relations of the Uterus.—The position occupied by the
the pelvis is not always the same, but varies with the conditions of the ring organs. The lower cervical part is, however, much more firmly fixed than the body and fundus, which possess a considerable amount of mobility. the level of the external orifice of the uterus will be found to correspond of a horizontal plane passing through the upper margin of the symphysis The uterus rarely lies exactly in the median plane of the body, but usually
one or other side, most frequently towards the right. The vesical surface terus rests against the bladder, and follows the rising or falling of its superior that organ becomes filled or emptied. When the bladder is empty the long the uterus points forwards and upwards, and the organ is said to be in an ted position. Also, the long axis of the uterus is bent on itself where the body e cervix, and so the organ is said to be anteflexed. The anteflexion is due fact that the more rigid cervix is fixed, while the movable upper part of the sinks forwards, following the bladder wall. With the empty condition of dder the angle formed between the long axis of the uterus and that of the
is about a right angle. When the bladder becomes filled, the anteversion ateflexion of the uterus become less marked, owing to the body and fundus pushed backwards. Finally, if the rectum is empty and the bladder very distended, the uterus is pushed so much backwards that the long axis of the may nearly correspond to that of the vagina. The uterus is then said to be erted. Superiorly a part of the peritoneal cavity intervenes between the al surface of the uterus and the bladder, but lower down the two organs are ated merely by a small quantity of connective tissue. The intestinal surface e uterus looks into the pouch of Douglas, and is usually, like the fundus, in on to some loops of the small intestine or pelvic colon. Laterally the uterus ated to the broad ligaments. The terminal parts of the ureters pass downwards, ally, and a little forwards on the lateral aspects of the cervix, but are separated
it by an interval of about three-quarters of an inch. The lowest part of the ix is, as we have seen, enclosed within the cavity of the vagina. On each side of the cervix uteri and upper part of the vagina there is an rval in which lie numerous large vessels. These are surrounded by loose fatty ue, which is continued upwards for a considerable distance between the layers the broad ligament. This loose tissue, which is of surgical importance, has eived the name parametrium.,
y is a solid body, flattened from side to side, and about the size and rge almond. Its length is usually between one and one and a half the thickness from side to side between a quarter and half an inch.
the ovary is placed against the side wall of the pelvic cavity, and is y peritoneal folds with the broad ligament of the uterus and with the f the pelvis. The position occupied by the ovary within the pelvic
irly constant, although these ligaments do not hold the organ firmly - definite place. ovary we recognise two extremities—a superior extremity, larger and ed, and an inferior extremity, somewhat pointed. The term extremitas
29.—SIDE WALL OF THE FEMALE PELVIS, showing the position of the ovary and its relation to the uterine tube. The pelvis has been cut in section parallel to, but at some distance from, the median plane.
ia is applied to the superior end of the ovary, as it is most intimately ected with the uterine tube; the term extremitas uterina is used with reference ne inferior extremity, since this part of the ovary is connected with the uterus - fibrous cord, termed the ligament of the ovary. The flattened surfaces of the y are called facies medialis and facies lateralis, and the borders separating n—margo mesovaricus or mesovarian border, and margo liber or free border. The border is convex; while the mesovarian, which is straighter and narrower, is nected by a very short peritoneal fold, the mesovarium, with the posterior layer the broad ligament of the uterus. The vessels and nerves enter the ovary at s mesovarian border, which is therefore often termed the hilum of the ovary. Position and Relations of the Ovary. When the ovary occupies its most nal, or typical, position the long axis of the gland is vertical. Its lateral rface lies against the wall of the pelvis, and its medial surface looks medially wards the pelvic cavity. The peritoneum of the pelvic wall, where the ovary lies