Superior hypogastric plexus


The superior hypogastric plexus is a plexus of nerves situated on the vertebral bodies anterior to the bifurcation of the abdominal aorta.

Structure

From the plexus, sympathetic fibers are carried into the pelvis as two main trunks- the right and left hypogastric nerves- each lying medial to the internal iliac artery and its branches.
The right and left hypogastric nerves continues as Inferior hypogastric plexus; these hypogastric nerves send sympathetic fibers to the ovarian and ureteric plexuses, which originate within the renal and abdominal aortic sympathetic plexuses.
The superior hypogastric plexus receives contributions from the two lower lumbar splanchnic nerves, which are branches of the chain ganglia.
They also contain parasympathetic fibers which arise from pelvic splanchnic nerve and ascend from Inferior hypogastric plexus; it is more usual for these parasympathetic fibers to ascend to the left-handed side of the superior hypogastric plexus and cross the branches of the sigmoid and left colic vessel branches, as these parasympathetic branches are distributed along the branches of the inferior mesenteric artery.
The SHP is the continuation of the abdominal aortic plexus.

Relation to the spinal cord

The nerves of the superior hypogastric plexus return to the spinal cord through the lumbar splanchnic nerves.

Proximity to major vasculature

The superior hypogastric plexus or presacral nerve is located in the interiliac triangle overlying the sacral promontory. At this location, the presacral nerve is in close proximity to major vasculature and the ureters.

Clinical significance

is a laparoscopic procedure where superior hypogastric plexus is excised, so that the pain pathway is cut off from the spinal column. This procedure is done to manage chronic pelvic pain when conservative medical therapy fails.

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