Vesicouterine pouch

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. 

To diagnose bladder endometriosis at MRl, natural bladder distention by urine helps to identify small T2- and Tl-hypointense nodules, most often located in the bladder dome, anterior to the vesicouterine pouch. Small Tl-hyperintense portions may co-ex-ist and correspond to haemorrhagic portions of the lesion. At contrast-enhanced imaging, the lesion enhances more than the noninvaded normal bladder detrusor [35] (Fig. 11.2). 

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