Overview
Most of the lymphatic drainage of the pelvic viscera is into the lymph
nodes associated with the internal and external iliac arteries and their
branches. These drain into lymph nodes distributed along the common iliac
arteries and then into the para-aortic lymph nodes which are related to the
abdominal aorta.
Gross Anatomy
The main
lymph node groups in and around the pelvis are:
1)
Inferior
mesenteric lymph nodes drain into à Para-aortic lymph nodes
2)
Internal
iliac lymph nodes à
Common iliac lymph nodes
3)
External
iliac lymph nodes à
Common iliac lymph nodes
4)
Superficial
and deep inguinal lymph nodes à
External iliac lymph nodes
5)
Sacral
lymph nodes à Internal
iliac / Common iliac lymph nodes
The sacral
lymph nodes are situated in the concavity of the sacrum. They are closely
related to the middle and lateral sacral arteries.
The table
below gives a simplified outline of the drainage of the pelvic viscera. Several organs are drained by more than one lymph
node group.
|
Para-aortic Testis
and ovary Body of
uterus Common iliac nodes |
Inferior mesenteric Superior
rectum Sigmoid |
Sacral lymph nodes Rectum
(lower) Prostate |
|
External iliac Cervix Vagina
(upper) Body of
uterus Membranous
urethra (male) Cavernous
urethra (male) Prostate Seminal
vesicles Glans
penis/clitoris Intra-pelvic
ureter Bladder (anterior) Inguinal nodes |
Internal iliac Cervix Vagina
(middle) Whole
urethra (female) Membranous
urethra (male) Prostatic
urethra (male) Prostate Seminal
vesicles Intra-pelvic
ureter Bladder (posterior) Inferior
rectum Upper
anal canal (above dentate line) |
Inguinal (superficial and deep) Vagina
(lower) Cavernous
urethra (male) Glans
penis/clitoris Perineum
and external genitalia (including scrotum/vulva) Anus Lower
anal canal (below dentate line) |
Clinical Anatomy
Important differentiations
to remember which will aid you clinically when faced with a patient with a prominent
lymph node:
- Useful in differentiating a scrotal lump versus
a testicular lump
- Testis à Para-aortic lymph
nodes
- Scrotum à Inguinal lymph nodes
- Remember to examine the anus and lower anal
canal (proctoscopy) in patients presenting with a palpable lymph node in
the groin. Anus and lower anal canal à inguinal lymph nodes.
Quick Anatomy
Key Facts
Aide-Memoire
Summary
The internal and external iliac lymph nodes provide the majority of the
lymphatic drainage of the pelvis. These lymph nodes then drain into the common
iliac lymph nodes followed by the para-aortic lymph nodes.