31

CASE 31


A 40-year-old African-American woman presented to the gynecologist complaining of bleeding between her periods and of low back pain on examination. In response to the physician’s questioning, the patient said her periods have been regular and the bleeding between her periods has gone on for 3 months. She also mentioned that her low back pain started about 6 weeks ago. The pelvic examination and an ultrasound study revealed multiple, medium-sized, firm masses in the uterus. The patient was diagnosed with a leiomyoma (fibroids) and she consented to a hysterectomy.



WHAT ARE THE LIGAMENTS THAT ATTACH TO THE UTERUS, UTERINE TUBES, AND OVARIES?


The internal organs of generation in the female have numerous ligaments that attach to them. The ligaments of the uterus are (Fig. 4-10):


• The broad ligament of the uterus, a double layer of peritoneum, attaches the lateral borders of the uterus to the lateral pelvic walls and pelvic floor. The broad ligament is divided into three parts: mesovarium, mesosalpinx, and mesometrium. The mesometrium is the largest division of the broad ligament and it attaches the body of the uterus, inferior to the ligament of the ovary, to the pelvic floor.

• The round ligaments of the uterus extend from the anterolateral borders of the uterine fundus. As they course anterolaterally in the pelvic cavity, they cross anterior to the ureters, branches of the internal iliac arteries, and external iliac arteries. They then enter the inguinal canals at the deep (internal) inguinal ring and leave at the superficial (external) inguinal ring to insert into the labia majora.

• The transverse cervical (cardinal) ligaments tether the cervix and vaginal fornix to the lateral walls of the pelvis. These are the most important ligaments supporting the uterus.

• The uterosacral ligaments attach the lateral walls of the cervix to the sacrum.

• The pubocervical ligaments extend from the anterior surfaces of the cervix and superior vagina to the pubic bones.

image

FIGURE 4-10 Ligaments of the female reproductive organs.


(Drake R, Vogl W and Mitchell A: Gray’s Anatomy for Students. Churchill Livingstone, 2004. Fig. 5-50.)


The ligaments of the ovary are (Fig. 4-10):


• The mesovarium. This extension of the broad ligament attaches to each ovary at its hilum.

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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 31

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