Anatomic Considerations

Sometimes referred to as presacral nerve, the superior hypogastric plexus is formed by the confluence of the lumbar sympathetic chains and branches of the aortic plexus, which contain fibers that traverse the celiac and inferior mesenteric plexuses (Figure 9-4.1). In addition, it usually contains parasympathetic fibers that originate in the ventral roots of S2-S4 and travel along pelvic splanchnic nerves through the inferior hypogastric plexus. The plexus is located in the retroperitoneum, anterior to the body of the lower part of L5, and upper part of S1. It is posterior to the bifurcation of the aorta and both common iliac arteries, and left common iliac vein. The superior hypogas-tric plexus divides into right and left hypogastric nerves, which descend lateral to the sigmoid colon and rectosig-moid to reach the two inferior hypogastric plexuses. The superior hypogastric plexus gives off branches to the ureteric and testicular (or ovarian) plexus, the sigmoid colon, and the internal iliac artery. In addition to the pathways that traverse the superior hypogastric plexus, sympathetic fibers also reach the plexus through perivascular pathways that include the inferior mesenteric plexus (sigmoid, colon, and rectum) and renal plexus (ureteric and ovarian or testicular plexuses).

t/r^--Sympathetic chain

Aortic_i plexus

Inferior hypogastric -i plexus

Figure 9-4.1. Anatomy of superior and inferior hypogastric plexuses. (Reprinted from Raj PP,Lou L,Erdine S,et al.Radiographic Imaging for Regional Anesthesia and Pain Management, p 231, Copyright 2003, with permission from Elsevier.)

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