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Pouch of Douglas (Rectouterine Pouch)

You're asking about the Pouch of Douglas - a key anatomical structure in the female pelvis. Here is a complete overview:

What It Is

The Pouch of Douglas (formally called the rectouterine pouch) is a peritoneal pocket - a bag-shaped extension of the peritoneum - located between the posterior wall of the uterus and the front of the rectum in females. It is named after the Scottish anatomist James Douglas (1675-1742).
It represents the deepest point of the peritoneal (abdominal) cavity in women, making it anatomically and clinically very important.

Anatomy & Boundaries

  • Anterior: posterior surface of the uterus and the posterior fornix of the vagina
  • Posterior: anterior wall of the rectum
  • Lateral: rectouterine folds (C19), which contain the sacrouterine ligaments and the inferior hypogastric nerve plexus
Because it is the most dependent (lowest) part of the peritoneal cavity, fluid naturally drains and pools here by gravity.
  • Color Atlas of Human Anatomy, Vol. 2, p. 443

Diagram

Female pelvic viscera showing the pouch of Douglas and surrounding structures
(In panel C, label 17 = vesicouterine pouch; the rectouterine pouch/Pouch of Douglas lies posterior to the uterus, between it and the rectum.)

Clinical Significance

Because it is the lowest point of the abdominal cavity, it is clinically important in several ways:
ConditionHow the Pouch Is Involved
AscitesFree fluid collects here first
Pelvic abscessPus from abdominal diseases (e.g., appendicitis, diverticulitis, Crohn disease) pools here, causing swinging fever, rectal mucous discharge, and urinary frequency
Ectopic pregnancy ruptureBlood pools in the pouch
EndometriosisFibrotic plaques form and can obliterate the pouch, sometimes involving the rectosigmoid colon
Drop metastasesCancer cells from ovarian, colonic, or other pelvic tumors seed here
Peritoneal dialysisCatheter tip is often placed here for fluid drainage
  • Pye's Surgical Handicraft, 22nd ed.
  • Grainger & Allison's Diagnostic Radiology

Clinical Procedures

  1. Culdocentesis - needle aspiration of fluid through the posterior vaginal fornix into the pouch; used to diagnose ruptured ectopic pregnancy or pelvic abscess
  2. Culdoscopy - endoscopic examination via the same route
  3. Digital rectal examination - the pouch can be palpated through the rectum; tenderness suggests pelvic peritonitis or a collection
  4. Surgical entry - in colorectal and gynecological surgery (e.g., the Altemeier perineal proctosigmoidectomy), the surgeon deliberately enters the pouch anteriorly to begin pelvic dissection

In Males

The equivalent space in males is called the rectovesical pouch - located between the bladder and the rectum. It has less clinical prominence but also acts as a dependent collection space. The two layers of Denonvilliers' fascia (behind the prostate) are embryologic remnants of the pouch of Douglas that extended down to the urogenital diaphragm.
  • Smith and Tanagho's General Urology, 19th ed.
In short, the Pouch of Douglas is a gravity-dependent peritoneal recess that acts as a natural sump for the pelvis - making it a critical landmark in gynecology, general surgery, and clinical examination.
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