Sagittal section of the lower part of a female trunk, right segment. (Excavatio recto-uterina labeled at bottom right.)
Median sagittal section of female pelvis. (Rectouterine excavation labeled at center left.)
|Latin||excavatio rectouterina, cavum douglassi, fossa douglasi|
The recto-uterine pouch, also known by various other names (e.g., 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
In women it is the deepest point of the peritoneal cavity, posterior to (behind) the uterus and anterior to (in front of) the rectum. (The pouch on the other side of the uterus is the vesico-uterine pouch.) It is near the posterior fornix of the vagina.
It is normal to have approximately 1 to 3 ml (or mL) of fluid in the recto-uterine pouch throughout the menstrual cycle. After ovulation there is between 4 and 5 ml of fluid in the recto-uterine pouch.
Naming and etymology
The recto-uterine (or rectouterine) pouch is also called the recto-uterine (or rectouterine) excavation, utero-rectal (or uterorectal) pouch, recto-vaginal (or rectovaginal) pouch, pouch of Douglas (after anatomist James Douglas, 1675–1742), Douglas pouch, Douglas cavity, Douglas space, Douglas cul-de-sac, Ehrhardt–Cole recess, Ehrhardt–Cole cul-de-sac, cavum Douglasi, or excavatio rectouterina. The combining forms reflect the rectum (recto-, -rectal) and uterus (utero-, -uterine).
In Obstetrics and Gynecology, it is commonly referred to as the pouch of Douglas or the posterior cul-de-sac.
The Douglas fold (rectouterine plica), Douglas line, and Douglas septum are likewise named after the same James Douglas.
A culdotomy or posterior colpotomy is an incision or needle puncture into this "cul-de-sac" pouch by way of the vagina.
The recto-uterine pouch can be used in the treatment of end-stage kidney failure in patients who are treated by peritoneal dialysis. The tip of the dialysis catheter is placed into the deepest point of the pouch.
- Severi FM, Bocchi C, Vannuccini S, Petraglia F (2012). "Ovary and ultrasound: from physiology to disease" (PDF). Archives of Perinatal Medicine. 18 (1): 7–19.
- synd/2937 at Who Named It?
- Hensen, Jan-Hein J.; Puylaert, Julien B. C. M. (2009-06-01). "Endometriosis of the Posterior Cul-De-Sac: Clinical Presentation and Findings at Transvaginal Ultrasound". American Journal of Roentgenology. 192 (6): 1618–1624. doi:10.2214/AJR.08.1807. ISSN 0361-803X.
- Drake, RL (2010). Gray's Anatomy for Students. Churchill Livingstone. p. 460.
- 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.
- Tsin, DA (2001). "Culdolaparoscopy: a preliminary report". JSLS. 5: 69–71. PMC 3015410. PMID 11303998.
- Anatomy photo:43:02-0300 at the SUNY Downstate Medical Center - "The Female Pelvis: Distribution of the Peritoneum in the Female Pelvis"
- Anatomy image:9610 at the SUNY Downstate Medical Center
- Anatomy image:9737 at the SUNY Downstate Medical Center
- Douglas'+Pouch at the US National Library of Medicine Medical Subject Headings (MeSH)
- peritoneum at The Anatomy Lesson by Wesley Norman (Georgetown University)
- figures/chapter_35/35-8.HTM: Basic Human Anatomy at Dartmouth Medical School
- "Anatomy diagram: 03281.000-2". Roche Lexicon - illustrated navigator. Elsevier. Archived from the original on 2015-06-11.