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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.
Cul-de-sac hernias are the most difficult to diagnose during physical examination, and to distinguish from anterior rectocele or enterocele. [2] Furthermore, rectocele and cul-de-sac hernia may occur together. [3] Combined vaginal and rectal digital palpation may be used (examiner's thumb in vagina, index finger in anal canal). [11]
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]
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).
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.
The rectovesical pouch is a space between the rectum and the bladder in men. [1] It lies above the seminal vesicles. [2] It is lined by peritoneum and at its base is the rectoprostatic fascia (Denonvillier's fascia).
The word culdoscope (and culdoscopy) is derived from the phrase cul-de-sac, which in French literally means "bottom of a sac", here referring to a blind pouch or cavity in the female body that is closed at one end, that is the rectouterine pouch. As early as the 13th century, a cul-de-sac was a dead-end street (or a dead-end way), a blind alley ...
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]