Rectouterine pouch

Last revised by Dr Daniel J Bell on 08 Apr 2021

The rectouterine pouch (TA: excavatio rectouterina 3), also known as the rectovaginal pouch, cul-de-sac or pouch of Douglas, is an extension of peritoneum between the posterior wall of uterus and the rectum in females. It is the most dependent part of the peritoneal cavity and is analogous to the rectovesical pouch in males.

  • anteriorly: uterus, posterior fornix of the vagina
  • posteriorly: rectum
  • inferiorly: peritoneal rectovaginal fold

Being the most dependent and lower area of the peritoneal cavity of females in the supine position, fluids (e.g. abscess, infection, ascites, hemoperitoneum, and even intraperitoneal drop metastases) preferentially collects here.

A small amount of homogeneous and low-attenuated fluid in the rectouterine pouch is normally seen in child-bearing age women.

The pouch is useful in end-stage renal failure patients, where it is a preferred place for peritoneal dialysis. The distal end of the tenckhoff catheter is placed in the pouch, and occasionally sutured to the bladder to avoid migration. 

It is named after the Scottish anatomist James Douglas (1675–1742) 2.

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Cases and figures

  • Figure 1
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