Recto-uterine pouch

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Recto-uterine pouch
WeiblichesBeckenMedian.gif
Sagittal section of the lower part of a female trunk, right segment. (Excavatio recto-uterina labeled at bottom right.)
Gray1230.png
Median sagittal section of female pelvis. (Rectouterine excavation labeled at center left.)
Details
Latin excavatio rectouterina, cavum douglassi, fossa douglasi
Identifiers
Gray's p.1152
MeSH A01.047.025.600.225
Dorlands
/Elsevier
e_18/12347073
TA A10.1.02.512
FMA FMA:14728
Anatomical terminology

The rectouterine pouch (or rectouterine excavation, rectovaginal, Ehrhardt-Cole Recess, cul-de-sac, cavum Douglasi or Pouch of Douglas) is the extension of the peritoneal cavity between the rectum and the posterior wall of the uterus in the female human body.

Structure and physiology[edit]

In women it is the deepest point of the peritoneal cavity, posterior to (behind) the uterus and anterior to (in front of) rectum. (The pouch on the other side of the uterus is the vesicouterine excavation.) It is near the posterior fornix of the vagina.

It is normal to have approximately 1 to 3 ml in the recto-uterine pouch throughout the menstrual cycle.[1] After ovulation there is between 4 and 5 ml of fluid in the recto-uterine pouch.[1]

In men, the region corresponding to the rectouterine pouch is the rectovesical excavation, which lies between the urinary bladder and rectum. (There is no equivalent to the vesicouterine excavation.)

Pathology[edit]

The rectouterine pouch, being the lowest part of the peritoneal cavity in a woman at supine position, is a common site for the spread of pathology such as ascites, tumour, endometriosis, pus, etc.

Naming and etymology[edit]

It is also known by the names Douglas pouch, Douglas cavity, Douglas space and Douglas cul-de-sac.[2]

It is named after the Scottish anatomist Dr. James Douglas (1675–1742) who extensively explored this region of the female body. Three other nearby anatomical structures are also named for him - the Douglas fold, the Douglas line and the Douglas septum.

Culdotomy[edit]

A culdotomy incision or needle puncture of this "cul-de-sac" pouch by way of the vagina.

Clinical significance[edit]

As it is the furthest point of the abdominopelvic cavity in women, it is a site where infection and fluids typically collect.[3]

The rectouterine pouch is used in the treatment of end-stage renal failure in patients who are treated by peritoneal dialysis. The tip of the dialysis catheter is placed into the deepest point of the pouch.

Additional images[edit]

See also[edit]

References[edit]

  1. ^ a b Severi FM, Bocchi C, Vannuccini S, Petraglia F (2012). "Ovary and ultrasound: from physiology to disease". Archives of Perinatal Medicine 18 (1): 7–19. 
  2. ^ synd/2937 at Who Named It?
  3. ^ Drake, RL (2010). Gray's Anatomy for Students. Churchill Livingstone. p. 460. 

Further reading[edit]

  • Gullmo A (1980). "Herniography. The diagnosis of hernia in the groin and incompetence of the pouch of Douglas and pelvic floor". Acta Radiologica. Supplementum 361: 1–76. PMID 6297246. 
  • Anaf V, Simon P, El Nakadi I, Simonart T, Noel J, Buxant F (February 2001). "Impact of surgical resection of rectovaginal pouch of douglas endometriotic nodules on pelvic pain and some elements of patients' sex life". The Journal of the American Association of Gynecologic Laparoscopists 8 (1): 55–60. doi:10.1016/s1074-3804(05)60549-x. PMID 11172115. 
  • Baessler K, Schuessler B (March 2000). "The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse". American Journal of Obstetrics and Gynecology 182 (3): 540–4. doi:10.1067/mob.2000.104836. PMID 10739505. 
  • Ostör AG, Nirenberg A, Ashdown ML, Murphy DJ (June 1994). "Extragenital adenosarcoma arising in the pouch of Douglas". Gynecologic Oncology 53 (3): 373–5. doi:10.1006/gyno.1994.1151. PMID 8206414. 

External links[edit]