Individual features of the innervation of the round ligament of the uterus and external genitalia

Abstract

Introduction. At any age the female reproductive system is prone to many diseases. Every year 371.2 thousand patients with cervical cancer are registered in the world. In Moldova 180-210 women die every year from cervical cancer, most of them are diagnosed at stage III-IV. Uterine fibroid is diagnosed in 30- 35% of women of reproductive age worldwide. Approximately for 70% of women this pathology requires surgical intervention. Knowledge of the anatomical variants of the structure of the genital organs vessels and nerves will improve the results of surgical intervention. Case presentation. Individual variants of the genitofemoral nerve on the corpse of a woman were studied, using the macroscopic method of preparation. There are 1-3 branches which depart from the femoral-genital nerve to the round ligament of the uterus in the inguinal canal. In most cases, the nerve with its branches is located behind the round ligament. When exiting through the superficial inguinal ring, the nerve branches in the skin of the labia majora. In our case, up to 6 branches from the sympathetic trunk connected with the genitofemoral nerve on the right. Reaching the inguinal canal, the genitofemoral nerve connected with the iliac-inguinal nerve to form a rich plexus. Both nerves in the inguinal canal had a tortuous trajectory and exchanged communicating nerve branches. The nerves exited the inguinal canal in one trunk, which then split into two branches located in front of the round ligament and ended in the labia majora. On the left side, 6 branches from the common iliac perivascular plexus joined the genitofemoral nerve, before entering the inguinal canal. In the inguinal canal, the genitofemoral nerve was located in front of the round ligament, giving off branches to it, and ran parallel to the ilioinguinal nerve. From the superficial ring of the inguinal canal, each nerve exited independently and was directed to the innervation of the labia majora. Discussion. The uterus and its ligamentous apparatus are innervated by the nerves of the autonomic nervous system and the lumbar plexus (S. D. Astrinsky). According to Anloague P.A., in almost 50% of cases of examination of cadaveric material, the genitofemoral nerve is represented by various anatomical variants: 20% of the nerves branch prematurely in the upper part (and not in the middle part) of the anterior surface of the psoas major muscle. Sometimes the genital and femoral branches do not merge into a common trunk and remain separate nerves as they pass into the pelvis. Conclusion. Knowledge of the individual features of the structure and innervation of the organs of the female genital area will improve the indicators of diagnosis and surgical treatment of women.