Rectouterine pouch

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]

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
Latinexcavatio rectouterina, cavum douglassi, fossa douglasi
MeSHD004312
TA98A10.1.02.512F
TA23726
FMA14728
Anatomical terminology

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 posterior 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
  • The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue).
    The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue).
  • Illu female pelvis
    Illu female pelvis

See also

References
  1. 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. 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. 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
  • 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 (2001). "Culdolaparoscopy: a preliminary report". JSLS. 5 (1): 69–71. PMC 3015410. PMID 11303998.
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