Rectouterine pouch
| Rectouterine 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.) | |
| Details | |
| Identifiers | |
| Latin | excavatio rectouterina, cavum douglassi, fossa douglasi |
| MeSH | D004312 |
| TA98 | A10.1.02.512F |
| TA2 | 3726 |
| FMA | 14728 |
| Anatomical terminology | |
Therectouterine pouch(recto-uterine pouch,pouch of Douglas,rectovaginal pouch,orcul-de-sac) is the extension of theperitoneuminto the space between the posterior wall of theuterusand therectumin the human female.[1]
Structure
[edit]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 theposterior fornixof thevagina.[1]The pouch on the other side of the uterus near to the anterior fornix is thevesicouterine 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 therectal ampulla(i.e. the inferior portion of the rectum).[3]
In men, the region corresponding to the rectouterine pouch is therectovesical pouch,which lies between theurinary bladderand rectum.
Peritoneal fluid
[edit]It is normal to have approximately 1 to 3ml(or mL) of fluid in the rectouterine pouch throughout themenstrual cycle.[4]Afterovulationthere is between 4 and 5 ml of fluid in the rectouterine pouch.[4]
Clinical significance
[edit]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 asascites,tumour,endometriosis,pus,etc.
As it is the furthest point of theabdominopelvic cavityin women, it is a site where infection and fluids typically collect.[5]
The rectouterine pouch can be used in the treatment of end-stagekidney failurein patients who are treated byperitoneal dialysis.The tip of thedialysis catheteris placed into the deepest point of the pouch.
Culdocentesis
[edit]Culdocentesisis a procedure that draws fluid from the pouch, by way of the vagina using a needle. Fluid drawn using a scalpel incision is called acolpotomy.
Naming and etymology
[edit]The rectouterine (or recto-uterine) pouch is also called the rectouterine excavation, uterorectal pouch, rectovaginal pouch, pouch of Douglas (after anatomistJames 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. Thecombining formsreflect the rectum (recto-,-rectal) and uterus (utero-,-uterine).
InObstetrics 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.
In popular culture
[edit]The Pouch of Douglas was featured in theNetflixspecialHannah Gadsby: Douglasto deconstruct patriarchy.[8]
InGhost 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
[edit]-
The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue). -
Illu female pelvis
See also
[edit]References
[edit]- ^abVasu, Balaji."Rectouterine pouch | Radiology Reference Article | Radiopaedia.org".Radiopaedia.Retrieved27 September2021.
- ^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,ISBN978-0-323-54800-7,retrieved2021-02-03
- ^Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017).Essential Clinical Anatomy.Lippincott Williams & Wilkins. p. 570.ISBN978-1496347213.
- ^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.
- ^Drake, RL (2010).Gray's Anatomy for Students.Churchill Livingstone. p. 460.
- ^abcdsynd/2937atWho 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.ISSN0361-803X.PMID19457826.
- ^Hannah Gadsby: Douglas reviewRolling Stone
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.PMID6297246.
- 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.PMID11172115.
- 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.PMID10739505.
- 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.PMID8206414.
- Tsin, DA (2001)."Culdolaparoscopy: a preliminary report".JSLS.5(1): 69–71.PMC3015410.PMID11303998.
External links
[edit]- Anatomy photo:43:02-0300at the SUNY Downstate Medical Center - "The Female Pelvis: Distribution of the Peritoneum in the Female Pelvis"
- Anatomy image:9610at the SUNY Downstate Medical Center
- Anatomy image:9737at the SUNY Downstate Medical Center
- Douglas'+Pouchat the U.S. National Library of MedicineMedical Subject Headings(MeSH)
- peritoneumat 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 fromthe originalon 2015-06-11.
