Broad Ligament and Its Contents
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Direct answer
A double fold of peritoneum stretching from the lateral border of the uterus to the lateral pelvic wall, the broad ligament is really three ligaments in one sheet — the mesometrium around the uterus, the mesosalpinx beneath the tube and the mesovarium attaching the ovary. Its contents read like a viva answer sheet: the fallopian tube, round ligament and ovarian ligament, the uterine and ovarian vessels, the ureter at its base, and the mesonephric remnants — epoophoron, paroophoron and the duct of Gartner — whose cysts and tumours punctuate gynaecological practice.
What you must remember
- Three parts: mesometrium (the main fold), mesosalpinx (between tube and ovary, holding the epoophoron), mesovarium (the posterior fold by which the ovary hangs).
- Fallopian tube parts: intramural (about 1 cm, within the uterine wall), isthmus (narrow, about 2 to 3 cm), ampulla (the fertilisation site and the commonest site of ectopic pregnancy), and the infundibulum with its fimbriae including the ovarian fimbria.
- Round ligament: from the uterus just below the tube's entry, through the inguinal canal to the labium majus — and with it a lymphatic route from the fundus to the superficial inguinal nodes.
- Ovarian attachments: the mesovarium and proper ovarian ligament medially; the suspensory ligament of the ovary laterally, carrying the ovarian vessels from the aorta.
- Mesonephric remnants: epoophoron (organ of Rosenmuller) with its longitudinal duct and tubules in the mesosalpinx; paroophoron more medially; a persistent duct of Gartner forms anterolateral vaginal wall cysts.
- Ureter: passes in the base of the broad ligament about 2 cm lateral to the cervix, beneath the uterine artery — the relation injured in hysterectomy.
- Clinical tag: para-ovarian cysts arise from the epoophoron between tube and ovary and are separated from the ovary at surgery by their own pedicle.
Working through an ectopic pregnancy
A 26-year-old with six weeks of amenorrhoea has unilateral pelvic pain and a positive pregnancy test; transvaginal ultrasound shows an empty uterus with a mass beside the left ovary and free fluid in the pouch of Douglas. The tube's regional anatomy frames every decision. The ovum almost always implants in the ampulla, the roomiest, most vascular part; erosion of the tubal wall and its vessels bleeds into the broad ligament's loose connective tissue and then into the peritoneal cavity through the fimbrial end. Salpingostomy preserves the tube because the isthmus and intramural parts remain intact; salpingectomy removes it with the mesosalpinx, taking care to spare the ovarian vessels in the suspensory ligament and the uterine artery's anastomotic arcade at the cornu.
The same sheet explains the rarer findings: a cyst of the epoophoron — a para-ovarian cyst — sits between tube and ovary, mobile on its own pedicle, distinct from ovarian cysts on imaging; a Gartner duct cyst presents as an anterolateral vaginal swelling in a woman whose kidneys may also be abnormal, since mesonephric duct and ureteric bud share an embryology.
Where students slip
The round ligament is credited with supporting the uterus; it is a weak secondary support, its real claim to fame being the lymphatic pathway by which endometrial carcinoma of the fundus reaches the superficial inguinal nodes — a favourite MCQ. The epoophoron and paroophoron are swapped: epoophoron lies laterally in the mesosalpinx with a longitudinal duct, the paroophoron lies medially and is gone by adult life. And the mesovarium attaches the ovary by its anterior border, so the ovarian vessels enter through the suspensory ligament and then cross the mesovarium — "ovary on a stalk" is only half the story.
Frequently asked questions
What are the three parts of the broad ligament?
Mesometrium around the uterus, mesosalpinx between the tube and the ovary, and the mesovarium attaching the anterior border of the ovary to the posterior leaf.
Name the mesonephric remnants in the broad ligament.
The epoophoron with its longitudinal duct and tubules in the mesosalpinx, the paroophoron medially, and the duct of Gartner, whose persistence forms anterolateral vaginal cysts.
Which parts does the fallopian tube have?
Intramural, isthmus, ampulla and infundibulum with fimbriae; fertilisation occurs in the ampulla, the commonest site of ectopic implantation.
How does fundal carcinoma reach the groin?
Via lymphatics accompanying the round ligament through the inguinal canal to the superficial inguinal nodes.
Where does the ureter run relative to the broad ligament?
In its base, about 2 cm lateral to the cervix, passing beneath the uterine artery — the crossing endangered during hysterectomy.
What is a para-ovarian cyst?
A cyst of the epoophoron in the mesosalpinx, lying between tube and ovary with its own pedicle, separate anatomically and surgically from ovarian cysts.