SIGNIFICANCE OF VASCULAR ANASTOMOSIS IN THE MESOSALPINX

by H. B. SINHA, M.S. (Pat.) , M.R.C.O.G., Lecturer in Obstetrics and Gynaecology, P. W . M edical College , Patna University.

It is customary to consider en do ­ tubes prevents it from· becoming crine deficiencies to be the result of gangrenous when acutely inflamed metabolic disorders as evidenced by in which respect the oviduct is in studies of glandular histology, cyto­ marked contrast with the vermiform­ logy and histochemistry. Little appendix. R. G . Whitelaw (1958) thought is given to the possibility observes that loss of ovarian activity that disturbed vascular function may following hysterectomy may arise be an etiological factor in an endo­ from failure to ensure adequate blood crine dysfunction. Such a ·situation supply to the ovaries. is likely to arise in case of ovarian The angiological pattern of blood function following operations on the vessels in the mesosalpinx were stu­ fallopian tubes. It has been also our die-d in 63 cases of sterilisation. 29 """ clinical experience that some of the were operated within one month after patients complain of symptoms of child-birth; 33 after one month of ovarian dysfunction after operation delivery; and one after termination for sterilisation. With this point of of twelve weeks' pregnancy. The view, a naked eye study, in vivo, was method of anastomosis of blood ves­ undertaken on the angiological pat­ sels was identical on both sides tern of blood vessels in the mesosal­ except in two cases. The following pinx while performing operation for four patterns were recognised. sterilisation. Opportunity permitting a more accurate study may be pos­ 1. Single arcade connecting the sible in future following the tech­ anastomosing branches of the nique of Vinyl Resin injections with uterine and ovarian arteries subsequent corrosion on our surgical with the accompanying veins materials. (Fig. 1). It is placed 2-3 mm. The text books do not give the des­ below the lower border of the cription of vascular anastomosis in tube. In ten cases this type the mesosalpinx; and its influence on of arrangement of blood ves ­ ovarian blood supply does not seem sels was seen. to have been fully appreciated. W. 2. More than one arcade of anas­ Shaw (1936) suggests that vascular tomosing blood vessels in the - anastomosis in the mesosalpinx mesosalpinx was found in which supplies blood vessels to the 40 cases (Fig. 2). The vessels 346 JOURNAL OF ·OBSTETRICS AND GYNAECOLOGY OF INDIA .- forming the pillars of the - ~ - arcade ran obliquely across between the two layers of the broad ligament and the meso­ salpinx. Fig, 1, Blcod vessels anastcrncs1oc in a single arca~e 1!l the 3. In one case there were three meso5alp1n:.r:. layers of vascular arcades in the mesosalpinx as one finds in the mesentery (Fig. 3). 4. Blood vessels branch dichoto­ mously as they reach the lower border of the tube. This he. 2, Multiple arcade pattern type of angiological pattern of vascular anastomosis was observed m 13 cases 1n th• mesosalpinx. (Fig. 4). The angiological network in the mesosalpinx is formed by the anasto­ mosing branches of the ovarian and uterine vessels. Ovarian artery, a Fig, 3. More than one layer ot branch of the abdominal aorta, on its anastCDos1ns vascular course in the pelvis, runs between arcades in the mesosalpinx the two layers of the infundibula­ pelvic ligament, and enters the broad ligament of the uterus where it lies •-' below the uterine tube. At this point Fie. '+. it may get partially or completely Dichotomous branching pattern ot blood vessels occluded while performing salpin­ in the mesosalpinx. gectomy. The post-operative phlebo­ thrombosis may extend from the mesosalpinx to the hilum of the ovary. Both the above mentioned conditions, will affect the endocrine ween two unequal vessels is achieved through the interconnecting vessels function of the ovary. in the mesosalpinx. The angiological At the level of the ovary its artery pattern of blood vessels in the meso­ passes backward in the mesovarium, salpinx may have also to play a part and breaks into branches which pass in the equalisation of blood flow and through the inferior portion of the regulation of blood pressure in the venous network. Its terminal and ovary, to the importance of which other branches which anastomose factors, in relation to the function of with the corresponding uterine bran­ the gland, attention has been drawn ches are more slender. The terminal by Reynolds ( 1950). Through this part of the uterine artery is of good vascular anastomosis, part of the size and is easily recognised. A har­ venous blood, from the placental site monious intercommunication bet- in the upper segment of the uterus, VASCULAR ANASTOMOSIS IN THE MESOSALPINX 347

' drains in the ovarian veins which would be effective through the vas­ may become the seat of a thrombo­ cular anastomosis in the mesosalpinx. phlebitis following puerperal sepsis In conclusion, it may be observed (Smout, 1948). that vascular anastomosis in the The calibre of the veins is bigger mesosalpinx has to subserve many than that of the arteries. This diffe­ important functions in the physio­ rence is more marked during preg­ logy of internal genital organs; and nancy. Ovarian veins empty in the that this fact should always be borne renal vein or inferior vena cava to in mind while performing operations which thrombi-embolus may pass on the uterine appendages. ~ from the placental site via the plexus in the mesosalpinx or broad ligament. References The blood vessels are convoluted. 1. Gaubert F . and Puthes F .: Ciba There is stasis of venous blood which Symposium; 4-6, 194, 1957. carries hormones from the gland. This 2. Greenhill J. P .: Principles & Prac­ fact may explain unequal action of tice of Obstetrics; lOth edition. the hormones on the arteries and 3. Reynolds S. R. M.: Recent Progress veins during pregnancy or different In.Hormone Research; 5, 65, 1950. phases of the menstrual cycle. There­ 4. Shaw W.: Text Book Of Gyna~co­ fore after salpingectomy, the charac­ logy, 1936. ter of menstruation may change as a 5. Smout S. F. V. and Jacoby F.: result of disturbed utero-ovarian Gynaecological And Obstetrical ..- anastomosis. Lastly, if biochemistry Anatomy; 2nd ed., 1950. of the endometrium has any role to 6. Whitelaw R. G.: J. Obst. & Gyn. play in the function of the ovary, it B. E.; 65, 917' 1958.