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.
Contents
1Structure and physiology
2Pathology
3Naming and etymology
4Culdotomy
5Clinical significance
6Additional images
7See also
8References
9Further reading
10External 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 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.[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 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).
Pathology
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.
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,[2] Douglas cavity,[2] Douglas space,[2] Douglas cul-de-sac,[2] 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 most commonly referred to as the posterior cul-de-sac.[3]
The Douglas fold (rectouterine plica), Douglas line, and Douglas septum are likewise named after the same James Douglas.
Culdotomy
A culdotomy or posterior colpotomy is an 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.[4]
The recto-uterine 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
The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue).
Illu female pelvis
See also
Dolichodouglas
Vesicouterine excavation
References
^ abSeveri FM, Bocchi C, Vannuccini S, Petraglia F (2012). "Ovary and ultrasound: from physiology to disease" (PDF). Archives of Perinatal Medicine. 18 (1): 7–19.
^ abcdsynd/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.
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.
Tsin DA. Culdolaparoscopy: a preliminary report.
JSLS. 2001 Jan-Mar;5(1):69-71.
PMID 11303998
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". Roche Lexicon - illustrated navigator. Elsevier. Archived from the original on 2014-01-01.
v
t
e
Anatomy of the peritoneum and mesentery
General
Peritoneum
cavity
Mesentery
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
Ligamentum venosum
From dorsal mesentery
Greater omentum
Gastrophrenic ligament
Gastrocolic ligament
Gastrosplenic ligament
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
General
Cystohepatic triangle
Hepatorenal recess of subhepatic space
Abdominal wall
Inguinal triangle
Peritoneal recesses
Paracolic gutters
Paramesenteric gutters
Pelvic
Uterus/ovaries
Broad ligament of the uterus
Mesovarium
Mesosalpinx
Mesometrium)
Ovarian ligament
Suspensory ligament of ovary
Recesses
Male
Recto-vesical pouch
Pararectal fossa
Female
Recto-uterine pouch
Recto-uterine fold (Uterosacral ligament)
Vesico-uterine pouch
Ovarian fossa
Paravesical fossa
Retroperitonium
Spaces
Extraperitoneal space
Retroperitoneal space
Retropubic space
Authority control
TA98: A10.1.02.512F
UpToDate Contents
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…bladder off the lower uterine segment and anterior cervix. The posterior cul-de-sac (also referred to as the rectouterine pouch or pouch of Douglas) is the space between the uterus and rectum. Its borders are …
…irritation of the diaphragm with referred pain to the shoulder or pooling of blood in the posterior cul-de-sac (pouch of Douglas) with an urge to defecate may occur Ovarian torsion – Moderate to severe abrupt …
…which peritoneal fluid is aspirated from the posterior pelvic cul-de-sac (pouch of Douglas) through the posterior vaginal fornix. There are few indications for this procedure in current practice. Historically …
…a peritoneum-lined space referred to as the posterior cul-de-sac, pouch of Douglas, or rectouterine pouch The anatomic boundaries of the posterior cul-de-sac are: Inferiorly, the rectovaginal septum; Laterally …
…diaphragm, there may be referred pain that is felt in the shoulder. Blood pooling in the posterior cul-de-sac (pouch of Douglas) may cause an urge to defecate. The timing, character, and severity of abdominal …
English Journal
Does the clinical information play a role in the magnetic resonance diagnostic confidence analysis of ovarian and deep endometriosis?
Saba L, Ajossa S, Ledda G, Balestrieri A, Schirru F, De Cecco CN, Suri JS, Melis GB, Lavra F, Guerriero S.
The British journal of radiology. 2019 Apr;92(1096)20180548.
Some recent studies have explored how the experience in the observers change their performance in the endometriosis detection using MRI but the effects of the clinical information remains uncertain. The purpose of this study was to assess the effect of the clinical information in the diagnostic conf
Diagnostic Accuracy and Reproducibility of Predicting Cul-de-Sac Obliteration by General Gynaecologists and Minimally Invasive Gynaecologic Surgeons.
Leonardi M, Reid S, Lu C, Gerges B, Chang T, Rombauts L, Healey M, Chou D, Choi S, Al-Mashat D, Ahmed S, Magotti R, Nader R, Adno A, Condous G.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2019 Apr;41(4)443-449.e2.
Knowledge of rectouterine cul-de-sac state and consistent classification among surgeons are important in the surgical management of women with endometriosis. The objective of this study was to determine the diagnostic accuracy and interobserver and intraobserver agreement among general gynaecologist
The association between ultrasound-based 'soft markers' and endometriosis type/location: A prospective observational study.
Reid S, Leonardi M, Lu C, Condous G.
European journal of obstetrics, gynecology, and reproductive biology. 2019 Mar;234()171-178.
Evaluate whether symptoms and/or transvaginal ultrasound (TVS) 'soft markers' (ovarian immobility and/or site-specific tenderness (SST)) are associated with endometriosis type/location. Multicenter prospective observational study (January 2009 to February 2013) in tertiary centers for women with chr
In this tutorial, we will be looking at one of the anatomical spaces found in the female peritoneal cavity - the rectouterine pouch, also known as the Pouch of Douglas. Refresh your memory of the female ...
The rectouterine pouch, also known as the rectovaginal pouch, cul-de-sac or pouch of Douglas, is an extension of peritoneum between the posterior wall of uterus and the rectum in females. It is the most dependent part of the ...
Rectouterine pouch: An extension of the peritoneal cavity between the rectum and back wall of the uterus. The term "cul-de-sac," aside from being any "blind pouch or cavity that is closed at one end," is used specifically ...