{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T11:15:56Z","timestamp":1762082156608,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T00:00:00Z","timestamp":1672272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: The aim of the work is to define the morphological peculiarities of the pelvic autonomic nervous system (ANS) and their importance in the clinical and surgical interventions in the lesser pelvis. Material and methods: Anatomical variations in the formation of the pelvic ANS were observed in 20 cadavers. The study included 17 men (85%), aged 18 to 84, and 3 women, aged 27 to 86. The average age was 53.8 years. The subjects most often died by violent death in car accidents, by asphyxia, or by sudden death. The study was approved by the Ethics Committee of the Health Care Surveillance Authority, Bratislava, Slovakia. We studied cadavers without congenital or detected anomalies, cancer, deformities of the body, or spinal or abdominal surgeries within 24 h of death. We observed a relationship between the dimensions and the number of ganglia, as well as the number and course of nerve branches and anastomoses. In the pelvic area, we observed the hypogastric plexus superior, hypogastric plexus inferior, and the truncus sympathicus. In all cadavers, we clarified the lumbosacral plexuses after evisceration. In the lumbosacral region, the roots were defined based on their participation in the formation of the plexuses. To show the intimate relationship between both systems, we also focused on the details of the structure (rami communicantes) related to the connections of the ANS with the spinal nervous system. Results: Anatomical variations in the formation of the pelvic ANS were observed in all cases. We included cases with more than two truncus sympathicus ganglia as the segmental type. The segmental form occurred in 14 (70%) cases, and was concentrated in 6 (30%) cases. Rami communicantes provided anastomoses to the spinal nerves. Small ganglia were observed on the rami communicantes. With the concentrated type, we observed the division of the sympathetic and parasympathetic systems. With the segmental and concentrated forms, symptoms of the \u201cdiffuse form\u201d may occur, which we observed in all cases. We observed significant right-left asymmetry and differences in the formation of ganglia and anastomoses. Conclusions: This study allowed us to identify and describe the morphological peculiarities of the pelvic ANS and their possible influence on the clinical picture. Asymmetry and dependence of their occurrence on the type of ANS was observed. The variations were frequent. Their preoperative diagnosis is difficult to impossible. The absence or lack of intraoperative vigilance can lead to the damage of pelvic ANS during operations and blockades of the pelvic plexus. The acquired knowledge can be helpful in clarifying clinical signs and symptoms of these conditions.<\/jats:p>","DOI":"10.3390\/medicina59010072","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T02:59:01Z","timestamp":1672282741000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Morphological Peculiarities of the Pelvic Autonomic Nervous System and Their Impact on Clinical Interventions in the Lesser Pelvic Region"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5058-5356","authenticated-orcid":false,"given":"Roman","family":"Kuruc","sequence":"first","affiliation":[{"name":"Institute of Forensic Medicine, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia"},{"name":"Medico-Legal Department of Health Care Surveillance Authority, Antolsk\u00e1 11, 85107 Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9867-7698","authenticated-orcid":false,"given":"Andrea","family":"Sz\u00f3r\u00e1dov\u00e1","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia"},{"name":"Medico-Legal Department of Health Care Surveillance Authority, Antolsk\u00e1 11, 85107 Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jarmila","family":"Kristov\u00e1","sequence":"additional","affiliation":[{"name":"Faculty of Nursing and Professional Health Studies, Slovak Medical University, Limbov\u00e1 12, 83303 Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Sol\u00e1rov\u00e1","sequence":"additional","affiliation":[{"name":"Faculty of Nursing and Professional Health Studies, Slovak Medical University, Limbov\u00e1 12, 83303 Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6839-5000","authenticated-orcid":false,"given":"Jozef","family":"\u0160idlo","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia"},{"name":"Medico-Legal Department of Health Care Surveillance Authority, Antolsk\u00e1 11, 85107 Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktor","family":"Matej\u010d\u00edk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Comenius University, University Hospital, Limbov\u00e1 5, 83305 Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kachl\u00edk, D., Varga, I., B\u00e1\u010da, V., and Musil, V. 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