Pelvic Lymphatic Drainage

1. Para-aortic (lumbar) nodes: Gonads (derive blood supply from kidneys)

  • Male: Testis, Epididymis
  • Female: Ovaries, Fallopian tube (except isthmus and intra-uterine parts), Uterine fundus

2. Inferior mesenteric nodes: As of blood supply – to the structures derived from hindgut

  • Descending colon
  • Sigmoid colon
  • Superior-most rectum

3. Common iliac nodes: Receives external and internal iliac nodes; Drains into para-aortic nodes

4. Superficial inguinal nodes: Everything that can be touched with fingers with few exceptions:

  • Posterolateral part of calf (can be touched) – but drains to popliteal nodes
  • Glans clitoris and Glans penis with distal spongy urethra (can be touched) – but drains to deep inguinal nodes
  • Round ligament and cornu of uterus (cannot be touched) – but drains to superficial inguinal nodes

Hence, the drainage area is

  • Skin below umbilicus including scrotum, vulva and perianal skin with exceptions
  • Anal canal below pectinate line
  • Vagina inferior to hymen
  • Round ligament and cornu of uterus (exception)
pelvic lymphatic drainage
Wang, Tianyou & Xu, Yan & Shao, Wenyu & Wang, Chao. (2022). Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors. Frontiers in Medicine. 9. 922585. 10.3389/fmed.2022.922585. [CC BY 4.0]

5. Deep inguinal nodes: Glans clitoris, Glans penis and distal spongy urethra

6. Internal iliac nodes: All pelvic viscera, deep parts of perineum, gluteal muscles and posterior thigh with few exceptions:

  • Superior bladder
  • Superior pelvic ureter
  • Superior vagina, cervix and lower uterine body
  • Seminal gland, Ductus deferens (pelvic part), Spongy and intermediate urethra
  • Superior parts of rectum

Hence, the drainage area is

  • Base of bladder + Prostate and prostatic urethra
  • Lower pelvic ureter
  • Inferior rectum and anal canal above pectinate line
  • Body of uterus, cervix, upper and middle vagina
  • Inferior seminal glands, cavernosus bodies

7. External iliac nodes: Antero-superior pelvic structures

  • Superior bladder
  • Superior pelvic ureter
  • Lower body of uterus, Cervix and Upper vagina
  • Seminal gland, Ductus deferens (pelvic part), Intermediate and spongy urethra

7. Sacral nodes: Postero-inferior pelvic structures, Inferior rectum, Inferior vagina

8. Para-rectal nodes: Superior rectum

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