Rectouterine pouch

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Rectouterine pouch
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Sagittal section of the lower part of a female trunk, right segment. (Excavatio recto-uterina labeled at bottom right.)
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Median sagittal section of female pelvis. (Rectouterine excavation labeled at center left.)
Details
Identifiers
Latin excavatio rectouterina, cavum douglassi, fossa douglasi
MeSH D004312
TA98 A10.1.02.512F
TA2 3726
FMA 14728
Anatomical terminology

The rectouterine pouch (recto-uterine pouch, pouch of Douglas, or rectovaginal pouch) is the extension of the peritoneum into the space between the posterior wall of the uterus and the rectum in the human female. [1]

Contents

Structure

In women, the rectouterine pouch is the deepest point of the peritoneal cavity. It is posterior to the uterus, and anterior to the rectum. [2] Its anterior boundary is formed by the posterior fornix of the vagina. [1] The pouch on the other side of the uterus near to the anterior fornix is the vesicouterine pouch.

After passing over the fundus of the uterus, the peritoneum extends inferiorly along the entire posterior aspect of the uterus, reaching the posterior vaginal wall before reflecting superior-ward onto the anterior aspect of the rectal ampulla (i.e. the inferior portion of the rectum). [3]

In men, the region corresponding to the rectouterine pouch is the rectovesical pouch, which lies between the urinary bladder and rectum.

Peritoneal fluid

It is normal to have approximately 1 to 3 ml (or mL) of fluid in the rectouterine pouch throughout the menstrual cycle. [4] After ovulation there is between 4 and 5 ml of fluid in the rectouterine pouch. [4]

Clinical significance

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.

As it is the furthest point of the abdominopelvic cavity in women, it is a site where infection and fluids typically collect. [5]

The rectouterine 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.

Culdocentesis

Culdocentesis is a procedure that draws fluid from the pouch, by way of the vagina using a needle. Fluid drawn using a scalpel incision is called a colpotomy.

Naming and etymology

The rectouterine (or recto-uterine) pouch is also called the rectouterine excavation, uterorectal pouch, rectovaginal pouch, pouch of Douglas (after anatomist James Douglas, 1675–1742), Douglas pouch, [6] Douglas cavity, [6] Douglas space, [6] Douglas cul-de-sac, [6] 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 gynaecology, it is commonly referred to as the pouch of Douglas or the posterior cul-de-sac. [7]

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

The Pouch of Douglas was featured in the Netflix special Hannah Gadsby: Douglas to deconstruct patriarchy. [8]

In Ghost World , the trivia question at the cafe where Scarlett Johansson's character works is "where in the human body is the Douglas Pouch located?"

Additional images

See also

Related Research Articles

<span class="mw-page-title-main">Uterus</span> Female sex organ in mammals

The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

<span class="mw-page-title-main">Peritoneum</span> Serous membrane that forms lining of abdominal cavity or coelom

The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue. This peritoneal lining of the cavity supports many of the abdominal organs and serves as a conduit for their blood vessels, lymphatic vessels, and nerves.

<span class="mw-page-title-main">Gynecologic ultrasonography</span> Application of medical ultrasonography to the female pelvic organs

Gynecologic ultrasonography or gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs as well as the bladder, the adnexa, and the recto-uterine pouch. The procedure may lead to other medically relevant findings in the pelvis.This technique is useful to detect myomas or mullerian malformations.

<span class="mw-page-title-main">Lesser omentum</span>

The lesser omentum is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach, and to the first part of the duodenum. The lesser omentum is usually divided into these two connecting parts: the hepatogastric ligament, and the hepatoduodenal ligament.

<span class="mw-page-title-main">Inferior epigastric artery</span> Blood vessel

In human anatomy, the inferior epigastric artery is an artery that arises from the external iliac artery. It is accompanied by the inferior epigastric vein; inferiorly, these two inferior epigastric vessels together travel within the lateral umbilical fold The inferior epigastric artery then traverses the arcuate line of rectus sheath to enter the rectus sheath, then anastomoses with the superior epigastric artery within the rectus sheath.

<span class="mw-page-title-main">Round ligament of uterus</span> Ligament connecting the uterus to the labia majora

The round ligament of the uterus is a ligament that connects the uterus to the labia majora. It originates at the junction of the uterus and uterine tube. It passes through the inguinal canal to insert at the labium majus.

<span class="mw-page-title-main">Broad ligament of the uterus</span> Wide fold of peritoneum that connects the sides of the uterus to the walls and floor of the pelvis

The broad ligament of the uterus is the wide fold of peritoneum that connects the sides of the uterus to the walls and floor of the pelvis.

<span class="mw-page-title-main">Suspensory ligament of ovary</span> Part of human anatomy

The suspensory ligament of the ovary, also infundibulopelvic ligament, is a fold of peritoneum that extends out from the ovary to the wall of the pelvis.

<span class="mw-page-title-main">Pelvic cavity</span> Body cavity bounded by the pelvic bones

The pelvic cavity is a body cavity that is bounded by the bones of the pelvis. Its oblique roof is the pelvic inlet. Its lower boundary is the pelvic floor.

<span class="mw-page-title-main">Perimetrium</span>

The perimetrium is the outer serosal layer of the uterus, derived from the peritoneum overlying the uterine fundus, and can be considered a visceral peritoneum. It consists of a superficial layer of mesothelium, and a thin layer of loose connective tissue beneath it.

The paracolic gutters are peritoneal recesses – spaces between the colon and the abdominal wall.

<span class="mw-page-title-main">Vaginal fornix</span> Superior portions of the vagina

The fornices of the vagina are the superior portions of the vagina, extending into the recesses created by the vaginal portion of cervix. The word fornix is Latin for 'arch'.

<span class="mw-page-title-main">Pararectal fossa</span>

The pararectal fossa is an inferior-ward extension of the peritoneum on either side of the rectum. It is formed by a (sacrogenital) fold of peritoneum extending inferior-ward from the posterolateral pelvic wall. It represents a lateral extension of the rectouterine pouch in the female, and of rectovesical pouch in the male. It varies in size with the distension of the rectum.

<span class="mw-page-title-main">Rectouterine fold</span>

The rectouterine fold is a bilaterally paired prominent ridge/fold of the peritoneum that represents the lateral boundary of the rectouterine pouch on either side. It is formed by the underlying rectouterine muscle. On either side, the rectouterine fold extends between the sacrum medially, and the base of the broad ligament of the uterus laterally.

<span class="mw-page-title-main">Vesicouterine pouch</span> Fold of peritoneum in human female anatomy

In human female anatomy, the vesicouterine pouch, also uterovesicle pouch, is a fold of peritoneum over the uterus and the bladder. Like the rectouterine pouch, it is a female pelvic recess, but shallower and closer to the anterior fornix of the vagina.

<span class="mw-page-title-main">Retropubic space</span>

Retropubic space is a potential avascular space located between the pubic symphysis and the urinary bladder. The retropubic space is a preperitoneal space, located behind the transversalis fascia and in front of peritoneum.

<span class="mw-page-title-main">Rectovesical pouch</span> Part of pelvic anatomy in male mammals

The rectovesical pouch is the pocket that lies between the rectum and the bladder in males in humans and other mammals. It is lined by peritoneum.

<span class="mw-page-title-main">Uterosacral ligament</span>

The uterosacral ligaments are major ligaments of uterus that extend posterior-ward from the cervix to attach onto the sacrum.

<span class="mw-page-title-main">Omental foramen</span> Part of the human abdomen

In human anatomy, the omental foramen, is the passage of communication, or foramen, between the greater sac, and the lesser sac.

In medicine, excavation has two meanings:

References

  1. 1 2 Vasu, Balaji. "Rectouterine pouch | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 27 September 2021.
  2. ↑ 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, doi:10.1016/B978-0-323-54800-7.50047-7, ISBN   978-0-323-54800-7 , retrieved 2021-02-03
  3. ↑ Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy. Lippincott Williams & Wilkins. p. 570. ISBN   978-1496347213.
  4. 1 2 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.
  5. ↑ Drake, RL (2010). Gray's Anatomy for Students. Churchill Livingstone. p. 460.
  6. 1 2 3 4 synd/2937 at Who Named It?
  7. ↑ 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.
  8. ↑ Hannah Gadsby: Douglas review Rolling Stone

Further reading

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