Pouch of Douglas

Fig. 1. 61a-d. Perforated appendicitis phlegmon and abscess. a,b Phlegmon. Inflammatory mass composed of a complex fluid collection (C), prominent mesenteric fat (M), and adjacent thickened poorly defined intestinal bowel loops (B) just close to the appendiceal remnants (arrows). c,d Abscesses. Distant multiple abscesses in the pouch of Douglas and in the subhepatic region. A, abscess... 

The FIGO classification is based on mucosal infiltration of these organs because the outer wall layers are not amenable to evaluation by endoscopy and biopsy. MRI, on the other hand, already identifies infiltration of the outer muscular layer of the bladder and rectum. Tumor extension to the rectum is either through invasion of the sacrouterine ligament or through direct infiltration of the pouch of Douglas with subsequent extension of the tumor to the anterior rectal wall (Fig. 7.31). The peritoneal fold of the rectouterine space (pouch of Douglas), on the... 

Most of the uterus is covered by peritoneum (Fig. 3.5). The peritoneum contributes only little support but ensures adequate mobility of the uterus relative to the urinary bladder and rectum, which is necessary to adj ust to the variation in bladder filling and especially during pregnancy. The peritoneum extends from the roof of the urinary bladder to the anterior uterine wall, forming the vesicouterine pouch in between. Below this fold, there is the vesicouterine ligament. The posterior peritoneal coat of the uterus extends downward to form the rectouterine pouch (Douglas space) that reaches to the level of the posterior vaginal fornix and from there extends to cover the anterior rectal wall. 

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