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Rectouterine pouch

Anatomy of the rectouterine pouch.

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Hey everyone! This is Nicole from Kenhub, and in this tutorial, we will be looking at one of the anatomical spaces found in the female peritoneal cavity – the rectouterine pouch.

So we're going to begin this tutorial by having a quick look at both the male and female peritoneal cavities in a sagittal view. And of course we have our male cross-section on the left and the female cross-section on the right with the peritoneal cavities of both highlighted in green. And we can see on both images that the peritoneum of both the male and female peritoneal cavity is reflected from the anterior wall of the pelvic cavity onto the surface of the urinary bladder. So, over here and here, we have the peritoneum reflecting back. Although notes that we also have the uterus in the female image.

So now we're just looking at our male peritoneal and pelvic cavities, and we can see in the male peritoneal cavity that the peritoneum over the surface of the urinary bladder is continuous with the peritoneum covering the surface of the rectum and the space between the two structures is called the rectovesical pouch. However, in the female peritoneal cavity, the rectovesical pouch does not exist since the uterus and vagina lie between the urinary bladder and the rectum. Instead, the peritoneum from the surface of the urinary bladder is reflected onto the anterior wall of the uterus forming the narrow vesicouterine pouch and continues along the posterior wall of the uterus where it reflects onto the anterior wall of the rectum thereby forming a recess called the rectouterine pouch and this recess is also known as the pouch of Douglas.

And the rectouterine pouch is bounded by the uterus and the posterior fornix of the vagina anteriorly while posteriorly it's bounded by the rectum and inferiorly, the rectovaginal fold. And the rectouterine pouch is the lowest part of the female peritoneal cavity, therefore, in a supine position, abscesses, infections, ascites and blood within the peritoneal cavity preferably collect into the rectouterine pouch. Additionally, due to its location, it's accessible to certain transvaginal procedures such as needle aspiration and endovaginal ultrasound.

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