Douglas room

from Wikipedia, the free encyclopedia

The Douglas space (Latin excavatio rectouterina ; in medical jargon also for short "Douglas") is a pocket-shaped protrusion of the peritoneum between the rectum at the back and the uterus at the front and extends to the back of the vaginal vault . In men, this peritoneum niche corresponds to the gap-shaped space between the rectum and the bladder, called the Excavatio rectovesicalis or Proust space . The rectouterine excavation in women and the rectovesical excavation in men represent the deepest point of the abdominal cavity in standing and seated people . Inflammation and malignant processes in the abdominal cavity can descend here, drip off and become encapsulated there, following gravity .

The name Douglas room connects this fissure-like cave with the name of the first describer, the English anatomist, surgeon and obstetrician James Douglas (1675–1742).

anatomy

Location of the Douglas space - labeled with Excavatio recto-uterina in the drawing

The woman's Douglas space is delimited by the following structures:

  • anterior (ventral) from the posterior wall of the uterus and the posterior vaginal vault
  • below (caudal) from the plica rectouterina
  • back (dorsal) of the rectum

In men, however, the corresponding rectovesical excavation delimits :

In veterinary anatomy, the term Douglas space is not used, but the term Excavatio rectogenitalis . In contrast to people standing upright, this peritoneum niche protrudes backwards (caudally). Your limits are:

  • above (dorsal): rectum
  • below (ventral): uterus or vas deferens , plica genitalis ( ligamentum latum uteri )
  • lateral: inner pelvic wall
  • back (caudal): retroperitoneal part of the pelvic cavity ("pelvic outlet")

Diagnostics and therapy

Douglas puncture

The Douglas space can be punctured through the vagina (Kuldozentese) and also through the abdominal wall. This is usually done to determine the germs in peritonitis , for the cytological diagnosis of malignant diseases when sowing via the abdominal cavity ( peritoneal carcinosis ) or to confirm intraperitoneal bleeding . Douching and relieving a Douglas abscess can also be carried out in this way.

In men, the only direct way to puncture the rectovesical excavation is through the rectum. Increasingly more often - at least outside the gynecological specialty - a CT- assisted puncture through the abdominal wall is performed.

Douglasoscopy

In Douglasoscopy (syn. Kuldoscopy), an endoscope is inserted through the posterior vaginal vault into the Douglas space. This allows the organs of the small pelvis (e.g. ovaries , adnexa ) to be viewed and tissue to be removed . Irrigation of the fallopian tube is also possible through this access.

laparoscopy

In an abdominal cavity , if adhesions do not prevent this, an insight and therapeutic measures can be carried out in the Douglas fir. This is done under general anesthesia.

Illnesses in the Douglas area

Adhesions in the Douglas space as a result of endometriosis

Endometriosis

The peritoneum of the Douglas space is often affected in endometriosis . Corresponding foci are found here in 28% of the patients.

Douglas abscess

With inflammation in the abdominal cavity (perforative appendicitis , peritonitis of other cause) and in the small pelvis (e.g. adnexitis ), purulent exudate can descend into the Douglas space, encapsulate itself there and thus form a Douglas abscess. This must be relieved by means of a puncture (see above).

Douglasocele

The Douglasocele is an internal hernia ( hernia ) in the Douglas space. As a rule, there is then a resilient protrusion in the posterior third of the vagina. The Douglasocele is usually associated with a descent of the uterus (Descensus uteri) and possibly with a rectocele .

literature

  • Winnie Achilles, Uwe Gille, Hans Geyer and others: Anatomy for veterinary medicine . Ed .: Franz-Viktor Salomon. 2nd, revised and expanded edition. Enke, Stuttgart 2008, ISBN 978-3-8304-1075-1 .
  • Herbert Lippert, Désirée Herbold, Wunna Lippert-Burmester: Anatomy, text and atlas . German and Latin names. 8th, revised edition. Elsevier, Urban & Fischer, Munich 2006, ISBN 978-3-437-26181-7 ( full text in the Google book search).
  • Karl-Josef Moll, Michaela Moll: Anatomy . Short textbook for the subject catalog. 18th, revised edition. Elsevier, Urban & Fischer, Munich / Jena 2006, ISBN 978-3-437-41743-6 .
  • Anton Johannes Waldeyer : Human anatomy . Ed .: Jochen Fanghänel. 17th, completely revised edition. Walter de Gruyter, Berlin / New York, NY 2003, ISBN 3-11-016561-9 ( full text in the Google book search - With 45 tables, up to the 16th edition under the title: Anton Waldeyer: Anatomy of people for students and Doctors ).

Individual evidence

  1. ↑ Douglas' cul-de-sac on Whonamedit.com
  2. ↑ Wolfgang Distler, Axel Riehn: Emergencies in gynecology and obstetrics . Springer Verlag, 2006, ISBN 3-540-25666-0 ( full text in the Google book search).
  3. ^ Adolf E. Schindler: Epidemiology, Pathogenesis and Diagnosis of Endometriosis. J Fertil Reprod 17 (2007), 22-27, online (PDF document; 205 kB)