Recto-uterine pouch

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Recto-uterine pouch
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.)
Latinexcavatio rectouterina, cavum douglassi, fossa douglasi
Anatomical terminology

The recto-uterine pouch, also known by vaginal fornix and 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.


In women, the recto-uterine pouch is the deepest point of the peritoneal cavity. It lies posterior to the uterus and anterior to the rectum.[1] (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.[2] After ovulation there is between 4 and 5 ml of fluid in the recto-uterine pouch.[2]

In men, the region corresponding to the recto-uterine pouch is the recto-vesical pouch, which lies between the urinary bladder and rectum. (There is no equivalent to the vesico-uterine pouch).

Clinical significance[edit]

The recto-uterine 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.

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

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.


A culdotomy or posterior colpotomy is an incision or needle puncture into this "cul-de-sac" pouch by way of the vagina.


Naming and etymology[edit]

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,[4] Douglas cavity,[4] Douglas space,[4] Douglas cul-de-sac,[4] 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.[5]

The Douglas fold (rectouterine plica), Douglas line, and Douglas septum are likewise named after the same James Douglas.

The Pouch of Douglas was also featured in Hannah Gadsby's Netflix Special "Douglas" to deconstruct patriarchy. [6]

Additional images[edit]

See also[edit]


  1. ^ Woodward, Paula J.; Griffith, James F.; Antonio, Gregory E.; Ahuja, Anil T., eds. (2018-01-01), "Ureters and Bladder", Imaging Anatomy: Ultrasound (Second Edition), Elsevier, pp. 424–433, ISBN 978-0-323-54800-7, retrieved 2021-02-03
  2. ^ a b 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.
  3. ^ Drake, RL (2010). Gray's Anatomy for Students. Churchill Livingstone. p. 460.
  4. ^ a b c d synd/2937 at Who Named It?
  5. ^ 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. PMID 19457826.
  6. ^

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.
  • Tsin, DA (2001). "Culdolaparoscopy: a preliminary report". JSLS. 5 (1): 69–71. PMC 3015410. PMID 11303998.

External links[edit]