| 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 (rectovaginal pouch,pouch of Douglas orcul-de-sac) is the extension of theperitoneum into the space between the posterior wall of theuterus and therectum in the human female.[1]
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 fornix of 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 bladder and rectum.
It is normal to have approximately 1 to 3ml (or mL) of fluid in the rectouterine pouch throughout themenstrual cycle.[4] Afterovulation there is between 4 and 5 ml of fluid in the rectouterine pouch.[4]
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 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-stagekidney failure in patients who are treated byperitoneal dialysis. The tip of thedialysis catheter is placed into the deepest point of the pouch.
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 acolpotomy.
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 forms reflect 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.
The Pouch of Douglas was featured in theNetflix specialHannah Gadsby: Douglas to 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?"
