Rectouterine pouch
{{Short description|Human female anatomical structure}}
{{Infobox anatomy
| Name = Rectouterine pouch
| Latin = excavatio rectouterina, cavum douglassi, fossa douglasi
| Image = WeiblichesBeckenMedian.gif
| Caption = Sagittal section of the lower part of a female trunk, right segment. (Excavatio recto-uterina labeled at bottom right.)
| Image2 = Gray1230.png
| Caption2 = Median sagittal section of female pelvis. (Rectouterine excavation labeled at center left.)
| System =
| Precursor =
}}
The rectouterine pouch (rectovaginal pouch, pouch of Douglas or cul-de-sac) is the extension of the peritoneum into the space between the posterior wall of the uterus and the rectum in the human female.{{cite web |last1=Vasu |first1=Balaji |title=Rectouterine pouch {{!}} Radiology Reference Article {{!}} Radiopaedia.org |url=https://radiopaedia.org/articles/rectouterine-pouch?lang=gb |website=Radiopaedia |access-date=27 September 2021}}
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.{{Citation|title=Ureters and Bladder|date=2018-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780323548007500477|work=Imaging Anatomy: Ultrasound (Second Edition)|pages=424–433|editor-last=Woodward|editor-first=Paula J.|publisher=Elsevier|doi=10.1016/B978-0-323-54800-7.50047-7 |language=en|isbn=978-0-323-54800-7|access-date=2021-02-03|editor2-last=Griffith|editor2-first=James F.|editor3-last=Antonio|editor3-first=Gregory E.|editor4-last=Ahuja|editor4-first=Anil T.}} Its anterior boundary is formed by the posterior fornix of the vagina. 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).{{cite book |last1=Moore |first1=Keith L. |title=Essential Clinical Anatomy |last2=Dalley |first2=Arthur F. |last3=Agur |first3=Anne M. R. |publisher=Lippincott Williams & Wilkins |year=2017 |isbn=978-1496347213 |pages=570}}
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.{{cite journal |url=http://www.ptmp.com.pl/archives/apm/18-1/APM181-1-Severi.pdf |title=Ovary and ultrasound: from physiology to disease |vauthors=Severi FM, Bocchi C, Vannuccini S, Petraglia F |journal=Archives of Perinatal Medicine |volume=18 |issue=1 |pages=7–19 |year=2012}} After ovulation there is between 4 and 5 ml of fluid in the rectouterine pouch.
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.{{cite book|last=Drake|first=RL|title=Gray's Anatomy for Students|year=2010|publisher=Churchill Livingstone|pages=460}}
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,{{WhoNamedIt|synd|2937}} Douglas cavity, Douglas space, Douglas cul-de-sac, 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.{{Cite journal|last1=Hensen|first1=Jan-Hein J.|last2=Puylaert|first2=Julien B. C. M.|date=2009-06-01|title=Endometriosis of the Posterior Cul-De-Sac: Clinical Presentation and Findings at Transvaginal Ultrasound|url=http://www.ajronline.org/doi/10.2214/AJR.08.1807|journal=American Journal of Roentgenology|volume=192|issue=6|pages=1618–1624|doi=10.2214/AJR.08.1807|pmid=19457826|issn=0361-803X}}
The Douglas fold (rectouterine plica), Douglas line, and Douglas septum are likewise named after the same James Douglas.
In popular culture
The Pouch of Douglas was featured in the Netflix special Hannah Gadsby: Douglas to deconstruct patriarchy.[https://www.rollingstone.com/tv/tv-features/douglas-hannah-gadsby-netflix-review-1002711/ Hannah Gadsby: Douglas review] Rolling Stone
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
File:Gray1035.png|The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue).
File:Illu female pelvis.jpg|Illu female pelvis
See also
References
{{Reflist}}
Further reading
- {{cite journal |author=Gullmo A |title=Herniography. The diagnosis of hernia in the groin and incompetence of the pouch of Douglas and pelvic floor |journal=Acta Radiologica. Supplementum |volume=361 |pages=1–76 |year=1980 |pmid=6297246}}
- {{cite journal |vauthors=Anaf V, Simon P, El Nakadi I, Simonart T, Noel J, Buxant F |title=Impact of surgical resection of rectovaginal pouch of douglas endometriotic nodules on pelvic pain and some elements of patients' sex life |journal=The Journal of the American Association of Gynecologic Laparoscopists |volume=8 |issue=1 |pages=55–60 |date=February 2001 |pmid=11172115 |doi=10.1016/s1074-3804(05)60549-x}}
- {{cite journal |vauthors=Baessler K, Schuessler B |title=The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse |journal=American Journal of Obstetrics and Gynecology |volume=182 |issue=3 |pages=540–4 |date=March 2000 |pmid=10739505 |doi=10.1067/mob.2000.104836}}
- {{cite journal |vauthors=Ostör AG, Nirenberg A, Ashdown ML, Murphy DJ |title=Extragenital adenosarcoma arising in the pouch of Douglas |journal=Gynecologic Oncology |volume=53 |issue=3 |pages=373–5 |date=June 1994 |pmid=8206414 |doi=10.1006/gyno.1994.1151}}
- {{cite journal | pmid = 11303998 | volume=5 | title=Culdolaparoscopy: a preliminary report | pmc=3015410 | year=2001 | journal=JSLS | pages=69–71 | last1 = Tsin | first1 = DA| issue=1 }}
External links
- {{SUNYAnatomyLabs|43|02|03|00}} - "The Female Pelvis: Distribution of the Peritoneum in the Female Pelvis"
- {{SUNYAnatomyImage|9|6|10}}
- {{SUNYAnatomyImage|9|7|37}}
- {{MeshName|Douglas'+Pouch}}
- {{NormanAnatomy|peritoneum}}
- {{DartmouthHumanAnatomy|figures/chapter_35/35-8.HTM}}
- {{cite web|url=http://www.tk.de/rochelexikon/pics/s03281.000-2.html|title=Anatomy diagram: 03281.000-2|work= Roche Lexicon - illustrated navigator|publisher= Elsevier|archive-url=https://web.archive.org/web/20150611020146/http://www.tk.de/rochelexikon/pics/s03281.000-2.html|archive-date=2015-06-11}}
{{Peritoneum}}
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