A 65-year-old man undergoes elective sigmoid colectomy for diverticular disease. During mobilisation of the sigmoid colon, the surgeon must identify and preserve a structure crossing the left iliac vessels to prevent retrograde ejaculation and infertility. What is this structure?
- A Superior hypogastric plexus (presacral nerve) ✓
- B Left ureter
- C Left gonadal vessels
- D Inferior mesenteric artery
Correct answer: A. Superior hypogastric plexus (presacral nerve)
Explanation
The superior hypogastric plexus (presacral nerve) lies in front of the aortic bifurcation and left common iliac vessels. Injury during sigmoid mobilisation or high ligation of the inferior mesoretic artery causes retrograde ejaculation and sexual dysfunction. The ureter is also at risk but its injury causes hydronephrosis, not ejaculatory dysfunction. Gonadal vessels are lateral.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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