A 34-year-old man is admitted to the emergency department after a traumatic landing into a swimming pool from a high diving platform. The patient has multiple traumas in his abdominal cavity. After a reconstructive operation of his abdominal organs the patient develops a high fever. Radiographic examination reveals that the lower portion of the descending colon and rectum has become septic and must be excised. Six months postoperatively the patient complains of impotence. Which of the following structures was most likely injured during the second operation?
A 34-year-old man is admitted to the emergency department after a traumatic landing into a swimming pool from a high diving platform. The patient has multiple traumas in his abdominal cavity. After a reconstructive operation of his abdominal organs the patient develops a high fever. Radiographic examination reveals that the lower portion of the descending colon and rectum has become septic and must be excised. Six months postoperatively the patient complains of impotence. Which of the following structures was most likely injured during the second operation?
π‘ Explanation
**Core Concept**
During the second operation, the patient underwent a colectomy involving the excision of the lower portion of the descending colon and rectum. This procedure is known as Hartmann's procedure, which is often performed in emergency situations to remove a septic segment of the colon. The patient's subsequent complaint of impotence suggests a possible injury to a nearby structure involved in erectile function.
**Why the Correct Answer is Right**
The inferior hypogastric plexus, also known as the pelvic plexus, is a network of nerves that plays a crucial role in erectile function. This plexus is located near the rectum and is at risk of injury during rectal surgery, including Hartmann's procedure. The inferior hypogastric plexus is responsible for transmitting sympathetic and parasympathetic signals that control erection.
**Why Each Wrong Option is Incorrect**
**Option A:** The rectal branch of the superior hypogastric plexus is not directly involved in erectile function. While it does innervate the rectum, it is not as closely associated with the inferior hypogastric plexus as the other options.
**Option B:** The superior rectal artery is a branch of the inferior mesenteric artery that supplies blood to the rectum. While it is nearby, it is not directly involved in erectile function.
**Option C:** The rectal nerves are indeed located near the rectum, but they are primarily involved in the sensation and motor control of the rectum, rather than erectile function.
**Clinical Pearl / High-Yield Fact**
The inferior hypogastric plexus is a key structure to remember when performing pelvic surgery, as injury to this plexus can result in erectile dysfunction. This is a classic exam trap, as many students may not associate rectal surgery with erectile function.
**Correct Answer: D. Inferior hypogastric plexus. The inferior hypogastric plexus, a network of nerves involved in erectile function, was most likely injured during the second operation.**
β Correct Answer: C. Pelvic splanchnic nerves
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