Rectouterine pouch

Human female anatomical structure

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[edit on Wikidata]

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.

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. 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).

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. 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.

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, 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.

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.

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).
Illu female pelvis

References

^ Vasu, Balaji. "Rectouterine pouch | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 27 September 2021.
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
Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy. Lippincott Williams & Wilkins. p. 570. ISBN 978-1496347213.
^ 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.
Drake, RL (2010). Gray's Anatomy for Students. Churchill Livingstone. p. 460.
^ synd/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. PMID 19457826.
Hannah Gadsby: Douglas review Rolling Stone

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 U.S. 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 2015-06-11.

Anatomy of the peritoneum and mesentery

General

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 Abdominal wall Inguinal triangle Peritoneal recesses Paracolic gutters Paramesenteric gutters