Recto-uterine pouch


The recto-uterine pouch, also known by [|various other names], is the extension of the peritoneal cavity between the rectum and the posterior wall of the uterus in the female human body.

Structure and physiology

In women it is the deepest point of the peritoneal cavity, posterior to the uterus and anterior to the rectum. It is near the posterior fornix of the vagina.
It is normal to have approximately 1 to 3 ml of fluid in the recto-uterine pouch throughout the menstrual cycle. After ovulation there is between 4 and 5 ml of fluid in the recto-uterine pouch.
In men, the region corresponding to the recto-uterine pouch is the recto-vesical pouch, which lies between the urinary bladder and rectum..

Pathology

The recto-uterine 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.

Naming and etymology

The recto-uterine pouch is also called the recto-uterine excavation, utero-rectal pouch, recto-vaginal pouch, pouch of Douglas, 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 and uterus.
In Obstetrics and Gynecology, it is commonly referred to as the pouch of Douglas or the posterior cul-de-sac.
The Douglas fold, Douglas line, and Douglas septum are likewise named after the same James Douglas.

Culdotomy

A culdotomy or posterior colpotomy is an incision or needle puncture into this "cul-de-sac" pouch by way of the vagina.

Clinical significance

As it is the furthest point of the abdominopelvic cavity in women, it is a site where infection and fluids typically collect.
The recto-uterine 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.

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