| Recto-uterine 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.)
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| 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 |
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.
Contents
- 1 Structure and physiology
- 2 Pathology
- 3 Naming and etymology
- 4 Culdotomy
- 5 Clinical significance
- 6 Additional images
- 7 See also
- 8 References
- 9 Further reading
- 10 External links
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 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
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
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
A culdotomy incision or needle puncture of this "cul-de-sac" pouch by way of the vagina.
Clinical significance
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
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The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue).
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See also
References
- ^ 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.
- ^ synd/2937 at Who Named It?
- ^ Drake, RL (2010). Gray's Anatomy for Students. Churchill Livingstone. p. 460.
Further reading
- 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
- 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 at Roche Lexicon - illustrated navigator, Elsevier
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Anatomy of the peritoneum and mesentery
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| General |
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| Abdominal |
From
ventral
mesentery |
- Lesser omentum
- Hepatoduodenal ligament
- Hepatogastric ligament
- Liver
- Coronary ligament
- (Left triangular ligament
- Right triangular ligament
- Hepatorenal ligament)
- Falciform ligament (Round ligament of liver and Ligamentum venosum in it, but not of it)
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|
From
dorsal
mesentery |
- Greater omentum
- Gastrophrenic ligament
- Gastrocolic ligament
- Gastrosplenic ligament
- Mesentery
- Transverse mesocolon
- Sigmoid mesocolon
- Mesoappendix
- Root of the mesentery
- Splenorenal ligament
- Phrenicocolic ligament
- Folds
- Umbilical folds
- Supravesical fossa
- Medial inguinal fossa
- Lateral umbilical fold
- Lateral inguinal fossa
- Ileocecal fold
|
|
Abdominal
cavity |
- Greater sac
- Lesser sac
- Omental foramen
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| General |
- Cystohepatic triangle
- Hepatorenal recess of subhepatic space
- Abdominal wall
- Peritoneal recesses
- Paracolic gutters
- Paramesenteric gutters
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| Pelvic |
| Uterus/ovaries |
- Broad ligament of the uterus
- Mesovarium
- Mesosalpinx
- Mesometrium)
- Ovarian ligament
- Suspensory ligament of ovary
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|
| Recesses |
- Male
- Recto-vesical pouch
- Pararectal fossa
- Female
- Recto-uterine pouch
- Recto-uterine fold (Uterosacral ligament)
- Vesico-uterine pouch
- Ovarian fossa
- Paravesical fossa
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| Spaces |
- Extraperitoneal space
- Retroperitoneal space
- Retropubic space
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Index of digestion
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| Description |
- Anatomy
- Physiology
- Development
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| Disease |
- Congenital
- Neoplasms and cancer
- Inflammatory bowel disease
- Gluten sensitivity
- Other
- Symptoms and signs
- Blood tests
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| Treatment |
- Procedures
- Drugs
- anabolic steroids
- antacids
- diarrhoea and infection
- bile and liver
- functional gastrointestinal disorders
- laxatives
- peptic ulcer and reflux
- nausea and vomiting
- other
- Surgery
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