 | This articleis missing information about pampiniform plexus in female - the origin of the ovarian veins. Please expand the article to include this information. Further details may exist on thetalk page.(November 2010) |
| Pampiniform plexus | |
|---|---|
 Spermatic veins | |
| Details | |
| Drains from | Testicle,epididymis |
| Drains to | Testicular vein |
| Identifiers | |
| Latin | plexus venosus pampiniformis, plexus pampiniformis |
| TA98 | A12.3.09.015 |
| FMA | 19607 |
| Anatomical terminology | |
Thepampiniform plexus (from Latin pampinus 'tendril' and forma 'form') is avenous plexus – a network of many smallveins found in the human malespermatic cord, and thesuspensory ligament of the ovary. In the male, it is formed by the union of multipletesticular veins from the back of thetestis and tributaries from theepididymis.
The veins of the plexus ascend along thespermatic cord in front of thevas deferens. Below thesuperficial inguinal ring they unite to form three or four veins, which pass along theinguinal canal, and, entering the abdomen through thedeep inguinal ring, coalesce to form two veins. These again unite to form a single vein, thetesticular vein, which opens on the right side into theinferior vena cava, at an acute angle, and on the left side into the leftrenal vein, at a right angle. The pampiniform plexus forms the chief mass of the cord.
In addition to its function in venous return from the testes, the pampiniform plexus also plays a role in the temperature regulation of the testes. It acts as acountercurrentheat exchanger, cooling blood in adjacent arteries. An abnormal enlargement of the pampiniform plexus is a medical condition calledvaricocele.
In females, the pampiniform plexus drains the ovaries. The right ovary drains to the pampiniform plexus to the ovarian vein to the inferior vena cava. The left ovary drains to the pampiniform plexus, left ovarian vein, then the left renal vein, to the inferior vena cava.[1]
Whilevaricocele is the diagnostic term for swelling in the valveless venous distribution of the male pampiniform plexus, this embryological structure, common to males and females, is often incidentally noted to be swollen during laproscopic examinations in both symptomatic and asymptomatic females.[2] Diagnosis of female varicocele, properly calledpelvic compression syndrome, should be expected to be as frequent as male varicocele (15% of healthy asymptomatic men which are thought to develop primarily during puberty and prevalence increases approximately 10% per decade of life[3]).
While one may expect that the female to have equal prevalence ofpelvic compression syndrome due to the identical embryological origin of the valveless pampiniform plexus, this condition is thought to be underdiagnosed due to the broad differential of the pain pattern: unilateral or bilateral pain, dull to sharp, constant to intermittent pain worsening with any increase in abdominal pressure.
Physical exam has specificity of 77% and sensitivity of nearly 94% when the patient is noted to be tender over adnexa during physical examination with a history of postcoital pain for differentiating pelvic congestion syndrome from other pathologies of pelvic origin.[4] Confirmatory imaging requires ultrasound while performing theValsalva maneuver, while the gold standard remains ovarian and iliac catheter venography showing veins5–10 mm in diameter during Valsalva.
Damage to the plexus duringinguinal hernia repair is the chief cause of ischaemicorchitis following this surgery; such orchitis typically presents within a week post-surgery and is almost always self-limiting. Its incidence is <1% for primary hernia repair, but more for recurrent hernia repairs.[5]
This article incorporates text in thepublic domain frompage 1240 of the 20th edition ofGray's Anatomy(1918)
