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A cul-de-sac hernia (also termed a peritoneocele) is a herniation of peritoneal folds into the rectovaginal septum (in females), [2] or the rectovesical septum (in males). The herniated structure is the recto-uterine pouch (pouch of Douglas) in females, [ 2 ] or the rectovesical pouch in males.
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 anterior fornix is the vesicouterine pouch.
Posterior enterocele (develops in the rectovaginal space, also termed the pouch of Douglas or the cul-de-sac). [2] Anterior enterocele (develops in the vesicovaginal space). [2] Retains the full thickness of the anterior vaginal wall. [2] Lacks vaginal wall (or very thin and ulcerated vaginal wall). [2] Anterior enterocele is rare. [2]
The vesicouterine pouch is a fold of peritoneum over the uterus and the bladder, forming a pelvic recess. [1] It is continued over the intestinal surface and body of the uterus onto its vesical surface, which it covers as far as the junction of the body and cervix uteri, and then to the bladder.
Culdoscopy is an endoscopic procedure performed to examine the rectouterine pouch and pelvic viscera by the introduction of a culdoscope through the posterior vaginal wall. [1] The word culdoscopy (and culdoscope) is derived from the term cul-de-sac, which means literally in French "bottom of a sac", and refers to the rectouterine pouch (or called the pouch of Douglas).
This cavity is a short, curved canal, deeper on its posterior than on its anterior wall. [1] Some sources consider this region to be the entirety of the pelvic cavity. Other sources define the pelvic cavity as the larger space including the greater pelvis , just above the pelvic inlet.
The examiner will look for any scarring or masses that may indicate cancer or another disease. Typically, a rectovaginal examination is performed to assess pelvic pain, rectal symptoms, or a pelvic mass. It can also provide a sample for fecal occult blood testing, but is controversial for this purpose (see below). [1] [2] [3] [4]
A cul-de-sac hernia (peritoneocele) is a herniation (protrusion) of peritoneal folds into the rectovaginal septum (the tissue between the rectum and the vagina) which does not contain any other abdominal organs. [19] [50] A sigmoidocele is a protrusion of the peritoneum between the rectum and vagina that contains a loop of the sigmoid colon. [19]