Recto-uterine pouch

The recto-uterine pouch, also known by various other names (e.g., pouch of Douglas), is the extension of the peritoneal cavity between the rectum and the posterior wall of the uterus in the female human body.

Recto-uterine 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.)
Latinexcavatio rectouterina, cavum douglassi, fossa douglasi
Anatomical terminology

Structure and physiology

In women it is the deepest point of the peritoneal cavity, posterior to (behind) the uterus and anterior to (in front of) the rectum. (The pouch on the other side of the uterus is the vesico-uterine pouch.) It is near the posterior fornix of the vagina.

It is normal to have approximately 1 to 3 ml (or mL) of fluid in the recto-uterine pouch throughout the menstrual cycle.[1] After ovulation there is between 4 and 5 ml of fluid in the recto-uterine pouch.[1]

In men, the region corresponding to the recto-uterine pouch is the recto-vesical pouch, which lies between the urinary bladder and rectum. (There is no equivalent to the vesico-uterine pouch).


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 (or rectouterine) pouch is also called the recto-uterine (or rectouterine) excavation, utero-rectal (or uterorectal) pouch, recto-vaginal (or rectovaginal) pouch, pouch of Douglas (after anatomist James Douglas, 1675–1742), Douglas pouch,[2] Douglas cavity,[2] Douglas space,[2] Douglas cul-de-sac,[2] Ehrhardt–Cole recess, Ehrhardt–Cole cul-de-sac, cavum Douglasi, or excavatio rectouterina. The combining forms reflect the rectum (recto-, -rectal) and uterus (utero-, -uterine).

In Obstetrics and Gynecology, it is most commonly referred to as the posterior cul-de-sac.[3]

The Douglas fold (rectouterine plica), Douglas line, and Douglas septum are likewise named after the same James Douglas.


A culdotomy or posterior colpotomy is an incision or needle puncture of 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.[4]

The recto-uterine pouch is used in the treatment of end-stage renal failure in patients who are treated by peritoneal dialysis. The tip of the dialysis catheter is placed into the deepest point of the pouch.

Additional images

See also


  1. Severi FM, Bocchi C, Vannuccini S, Petraglia F (2012). "Ovary and ultrasound: from physiology to disease" (PDF). Archives of Perinatal Medicine. 18 (1): 7–19.
  2. synd/2937 at Who Named It?
  3. Hensen, Jan-Hein J.; Puylaert, Julien B. C. M. (2009-06-01). "Endometriosis of the Posterior Cul-De-Sac: Clinical Presentation and Findings at Transvaginal Ultrasound". American Journal of Roentgenology. 192 (6): 1618–1624. doi:10.2214/AJR.08.1807. ISSN 0361-803X.
  4. Drake, RL (2010). Gray's Anatomy for Students. Churchill Livingstone. p. 460.

Further reading

  • Gullmo A (1980). "Herniography. The diagnosis of hernia in the groin and incompetence of the pouch of Douglas and pelvic floor". Acta Radiologica. Supplementum. 361: 1–76. PMID 6297246.
  • Anaf V, Simon P, El Nakadi I, Simonart T, Noel J, Buxant F (February 2001). "Impact of surgical resection of rectovaginal pouch of douglas endometriotic nodules on pelvic pain and some elements of patients' sex life". The Journal of the American Association of Gynecologic Laparoscopists. 8 (1): 55–60. doi:10.1016/s1074-3804(05)60549-x. PMID 11172115.
  • Baessler K, Schuessler B (March 2000). "The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse". American Journal of Obstetrics and Gynecology. 182 (3): 540–4. doi:10.1067/mob.2000.104836. PMID 10739505.
  • Ostör AG, Nirenberg A, Ashdown ML, Murphy DJ (June 1994). "Extragenital adenosarcoma arising in the pouch of Douglas". Gynecologic Oncology. 53 (3): 373–5. doi:10.1006/gyno.1994.1151. PMID 8206414.

Tsin DA. Culdolaparoscopy: a preliminary report. JSLS. 2001 Jan-Mar;5(1):69-71. PMID 11303998

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