Lymphatic vessels and nodes of the pelvis

In this note, we are going to discuss the main groups of pelvic lymph nodes and the pathways of lymphatic drainage from various tissues and organs in this region.

Lymphatic vessels and nodes of the pelvis

Pelvic lymph nodes are divided into parietal and visceral groups.

The parietal lymph nodes collect lymph from the hip bones, muscles, and fasciae. These nodes are located along major blood vessels. The main groups of parietal nodes include:

Common iliac nodes, which surround the common iliac vessels and receive lymph from the external and internal iliac nodes, directing it to the lumbar nodes.

External iliac nodes, which are located along the external iliac vessels. These nodes collect lymph from the lower limbs and pelvic organs, directing it into the common iliac nodes.

Internal iliac nodes, which are found along the internal iliac artery and its branches and are subdivided into three groups

Gluteal nodes (superior and inferior), which are situated along the gluteal vessels and drain lymph from the gluteal region and the walls of the pelvic cavity.

Obturator nodes, which are located along the obturator vessels and collect lymph from the anterior pelvic wall and the thigh.

Sacral nodes, which are positioned near the anterior sacral foramina and drain lymph from the posterior pelvic wall and the posterior rectum.

Subaortic lymph nodes, which are situated at the bifurcation of the aorta. They receive lymph from the common iliac nodes and direct it toward the lumbar nodes.

The visceral lymph nodes collect lymph from the pelvic organs and are divided into several groups:

Paravesical nodes, which are located in the connective tissue surrounding the urinary bladder.

Parauterine nodes, which are situated between the layers of the broad ligament of the uterus. They collect lymph from the uterus, ovaries, and uterine tubes.
Paravaginal nodes, which are positioned around the vagina, draining lymph from its structures.
Pararectal nodes, which surround the rectum and receive lymph from its lateral walls.

The majority of the visceral lymph nodes drain into the internal iliac nodes.

Lymphatic drainage from pelvic organs

The lymph from the organs of the pelvic cavity drains firstly into the visceral nodes and then into the parietal nodes.

Let’s explore the specific lymphatic pathways for some pelvic organs.

Rectum

Lymph from the upper part of the rectum flows to the superior anorectal nodes and subsequently to the inferior mesenteric nodes.
Lymph from the middle and lower parts drains into the pararectal nodes, then to the internal iliac nodes.
Lymph from the posterior part is directed to the sacral nodes and then to the lumbar nodes.
Lymph from the external anal sphincter and the skin of the anal region drains into the superficial inguinal nodes.

Uterus and uterine tubes

Lymph from the fundus and body of the uterus is directed to the lumbar nodes.
Lymph from the cervix drains into the internal iliac nodes.

Testes

Lymph from the parenchyma of the testes is drained by vessels within the spermatic cord to the lumbar nodes.
Lymph from the scrotum drains into the superficial inguinal nodes.

Prostate and seminal vesicles

Lymph from the prostate, bulbourethral glands, and seminal vesicles flows into the internal iliac nodes and then to the lumbar nodes.

Golosary