Innervation and Lymphatics of the Abdomen and Pelvis

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Blood vessels of the abdomen and pelvis | Main Anatomy Index | The pelvis

Last updated 30 March 2006

Autonomic Nervous Supply (Ashwell)

The sympathetic supply includes:

Greater splanchnic nerve (T5-9)
Lesser splanchnic nerve (T9-10)
Lowest (least) splanchnic nerve (T12)
Lumbar splanchnic nerves (L1-3)
Sacral splanchnic nerves

The parasympathetic supply includes:

Vagus nerve
Pelvic splanchnic nerve (S2-4)

These project to the paravertebral plexuses, which are situated anterior to the aorta and vertebral column.

Paravertebral Plexuses

Coeliac Plexus

This contains the paired coeliac ganglia and is located at the level of the last thoracic and 1^st lumbar vertebra.
It surrounds the root of the coeliac trunk and the superior mesenteric artery.

The coeliac ganglia are paired structures, which lie between the suprarenal glands and the coeliac trunk origin.
The lower part is partially detached and is sometimes referred to as the aorticorenal ganglion as it forms most of the renal plexus.

Secondary plexuses derived from or connected to the coeliac are the phrenic, splenic, left gastric, intermesenteric (aortic), suprarenal, renal, gonadal, superior mesenteric and inferior mesenteric.

Phrenic Plexus

This accompanies the inferior phrenic artery to the diaphragm and suprarenal gland.

Hepatic Plexus

This is the largest coeliac derivative and receives filaments from both the right and left vagus as well as from the phrenic nerves.

It accompanies the hepatic artery and the portal vein and their branches and also supplies the cystic plexus to the gallbladder.
Branches may also supply the pylorus, greater curvature of stomach as well as the lower bile duct, pancreatic head and 1^st and 2^nd part of duodenum.

Left Gastric Plexus

This goes to the lesser curvature of the stomach.

Splenic Plexus

This is formed by branches of the coeliac plexus, left coeliac ganglion and the right vagus.
It supplies the blood vessels and smooth muscles of the splenic capsule and trabeculae.

Suprarenal Plexus

This supplies the medulla of the suprarenal gland.

Renal Plexus

This is formed by fibres from the coeliac ganglion and plexus, aorticorenal ganglion, lowest thoracic splanchnic nerves, 1^st lumbar splanchnic nerve and the aortic plexus.

It gives off the ureter and gonadal plexuses (ovarian or testicular).
The ureteric plexus accompanies the ureter and the gonadal plexuses accompany the appropriate artery to the respective organs.

Superior Mesenteric Plexus

This is a downward extension of the coeliac plexus.
It accompanies the superior mesenteric artery to the pancreas, small intestine (duodenum, jejunum and ileum), and large intestine as far as the left trisection of the transverse colon.

Abdominal Aortic Plexus (intermesenteric)

This supplies the IVC, and testicular plexuses as well as connecting the superior and inferior mesenteric plexuses.

Inferior Mesenteric Plexus

This receives supply from the aortic plexus and 2^nd and 3^rd lumbar splanchnic nerves.
It supplies the colon from the left trisection of the transverse colon to the rectum.

Superior Hypogastric Plexus

This is situated anterior to the aortic bifurcation, L5 and the sacral promontory.
This plexus is formed from branches of the aortic plexus, 3^rd and 4^th lumbar splanchnic nerves.

It divides into the left and right hypogastric nerves, which descend to the 2 inferior hypogastric plexuses, which lie anterior to the sacrum.

Inferior Hypogastric Plexus

This is formed from the pelvic splanchnic nerves (from the sacral plexus, S2-4) and also receives the sacral splanchnic nerves.
Several plexuses arise from the inferior hypogastric plexuses, including:

Middle rectal plexus
Vesical plexus
Prostatic plexus
Uterovaginal plexus

Segmental Sympathetic Supplies and Referred Pain

Part	Segement(s)	Referred pain
Oesophagus (causal part)	T5-6	Retrosternal/epigastrium
Stomach	T6-10	Epigastrium
Small intestine (duodenum, ileum and jejunum)	T9-10	Umbilical
Large intestine to splenic flexure	T11-L1	Umbilical
Splenic flexure to rectum	L1-2	Hypogastrium
Liver and gallbladder	T7-9	Epigastrium/right hypochondrium
Spleen	T6-10	Left hypochondrium
Pancreas	T6-10	Epigastrium
Kidney	T10-L1	Posterior lumbar
Suprarenal	T8-L1	Posterior lumbar
Gonads	T10-11	Lumbar to groin
Urinary bladder	T11-L2	Hypogastrium
Uterus	T12-L1	Hypogastrium

Somatic Nervous Supply

Thoracoabdominal Nerves

These are branches of T6-11 intercostal nerves.

They are motor to the anterolateral abdominal wall muscles, sensory to the anterolateral abdomen, gluteal region and lateral side of thigh.
T10 supplies the umbilicus, T12 supplies a strip halfway between the umbilicus and pubic symphysis, T8 supplies a strip halfway between the umbilicus and xiphoid process.

Phrenic Nerve

This is from C3-5 and supplies the diaphragm and related pleura and peritoneum.
It contains both motor and sensory fibres.

Lumbar Plexus

Click here for a diagram of the lumbar plexus.
Click here for diagrams 1, 2 and 3 of the sacral plexus.

This extends from spinal nerves L2-4, but branches of L1 are often considered with the lumbar plexus.
L4 and L5 contribute to the sacral plexus by the lumbosacral trunk.

Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
Genitofemoral nerve (L1-2)
Lateral femoral cutaneous nerve (L2-3)
Femoral nerve (L2-4)
Obturator nerve (L2-4)

Lymphatics of the Posterior Abdominal Wall (Moore)

The lymph nodes lie along the aorta, inferior vena cava and iliac vessels.

The external iliac lymph nodes are scattered along the iliac vessels.

Inferiorly, the medial lymph nodes receive lymph from the lower limbs and pelvic viscera.
The lateral lymph nodes receive lymph from areas supplied by the inferior epigastric and deep circumflex iliac vessels.

The common iliac lymph nodes are scattered along the common iliac vessels.
They receive lymph from the external and internal iliac lymph nodes.

Lymph from the common iliac lymph nodes pass to the lumbar lymph nodes.

The Lumbar (Lateral Aortic) Lymph Nodes

These nodes lie on both sides of the abdominal aorta and IVC.

They receive lymph from the posterior abdominal wall, kidneys and ureter, testes or ovaries, uterus, and uterine tubes.
They also receive lymph from the descending colon, pelvis, and lower limb through the inferior mesenteric and common iliac lymph nodes.

Efferent lymph vessels from these large lymph nodes from the right and left lumbar lymph trunks.
These trunks terminate in the cisterna chyli.

The Cisterna Chyli

This is a sac-like expansion at the inferior end of the thoracic duct.

It is about 5 cm long and 6 mm wide and is frequently absent.
When present, it is located between the origin of the abdominal aorta and azygos vein.

It lies on the right side of the bodies of L1 and L2 vertebrae and is usually located posterior to the right crus of the diaphragm.

The cisterna chyli receives lymph from the right and left lumbar lymph trunks, the intestinal lymph trunks, and a pair of lymph vessels that ascend from the inferior intercostal lymph nodes.

Lymph from the digestive tract first passes to the lymph nodes close to the viscera concerned.
It then passes along lymph vessels that follow the major blood vessels to the nearest mesenteric lymph nodes.
From them, the lymph is carried to the lumbar lymph nodes.

The Thoracic Duct

This is the main lymphatic duct.
It begins at the cisterna chyli and ascends though the aortic hiatus in the diaphragm to the thorax.

It opens near or at the angle of the union of the internal jugular vein with the subclavian vein on the left side.