The "pouch" of the Douglas's pouch.

Hernia is described as the protrusion of an organ into the wall of its normal containing cavity. Internal hernia (IH) involves protrusion of viscera through: a peritoneal or mesentery defect, a normal or abnormal compartment of the peritoneal cavity. Hernias occurring in the pelvis cavity are usually classified according to the fascial margins breached and include sciatic, obturator and those through the rectouterin pouch: elytrocele and enterocele. Those hernias are defined by the protrusion of a viscus through the wall of the pelvis due to weakness of the pelvic fascia and/or muscles. Pelvic hernia through the pouch of Douglas (PD) involves the genital tract in female (elytrocele and enterocele). Sometimes described in the literature as Douglas hernia, this type of hernia must be distinguished from the conventional IH. As defined before, the borders to be considered for IH is the peritoneal membrane, which is not a real solid wall but delimitates the peritoneal cavity; and there is no peritoneal defect in elytrocele or enterocele. A PubMed search for IH through a defect in the peritoneal PD revealed only five female cases, making this an extremely rare condition. To our knowledge, we have presented here the only published case in a male. This probably congenital and morphologic anomaly (defect) of pouch of Sir Douglas must be distinguished as the real "Douglas IH". Authors discuss the concept of a new and more detailed classification of IH.

Anatomy of the sigmoid colon, rectum, and the rectovaginal pouch in women with enterocele and anterior rectal wall procidentia.

This study describes the anatomy of the rectovaginal pouch, the sigmoid colon, and rectum in women with posterior enterocele and anterior rectal wall procidentia. The anatomy of rectovaginal pouch, sigmoid colon, and rectum was described in 36 women with an enterocele (group A) and compared with those of 43 women (group B) without pelvic organ prolapse. Women with previous incontinence or prolapse surgery were excluded. The mean age in group A was 58 years (40-75) and in group B 35 years (19-64; P < 0.001). There were 15 nulliparas in group B. Nine women in group A had an internal anterior rectal wall procidentia, and one woman had an external anterior rectal wall procidentia. In group A, the rectovaginal pouch was significantly deeper, the sigmoid mesocolon at S1 shorter and showed more often a straight course (P < 0.05). These characteristics (termed "grande fosse pelvienne") were present in 23 women (64%) in group A and in 6 (14%) in group B, three of the latter were young nulliparas (P < 0.001). Age, parity, menopausal status, body mass index, constipation, and varicose veins were not associated with a grande fosse pelvienne. The typical anatomy in women with an enterocele and anterior rectal wall procidentia was a sigmoid colon with a straight course and a short mesentery at S1 and a rectovaginal pouch that covered more than half of the vaginal length. It may be a congenital condition and important in the development of an enterocele and rectal wall procidentia.

The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse.

OBJECTIVES: This study was undertaken to assess the depth of the pouch of Douglas among nulliparous women and to compare it with those among parous women and patients with genital prolapse. STUDY DESIGN: The depth of the pouch of Douglas was measured in 22 nulliparous women and 28 parous women without genital prolapse and in 18 patients with prolapse of the posterior vaginal wall. RESULTS: The pouch of Douglas extended from 11% to 89% of the total vaginal length among nulliparous and parous women, without significant difference between these groups (mean, 49% and 45%, respectively). It was significantly deeper in patients with prolapse, ranging from 25% to 96% (mean, 72%). CONCLUSION: There is an extensive variation in the depth of the pouch of Douglas. A deep pouch of Douglas is frequently present in young nulliparous women and may increase the risk for development of a posterior vaginal wall prolapse.

Bloqueo rectal por fondo de saco rectogenital profundo: nuestra experiencia / Deep pouch of Douglas: a series of 20 cases

La persistencia de un fondo de saco de Douglas profundo es, en algunos casos, un factor de constipación, manifestado como dificultad para lograr la evacuación rectal. Se analizan retrospectivamente los resultados obtenidos con la resolución operatoria de 20 pacientes del sexo femenino y que fueron intervenidas entre los años 1974 y 1995, portadoras de fondo de saco de Douglas profundo. La edad promedio era de 58 años (rango 24-83 años). Se enfatiza en la importancia del interrogatorio para establecer el diagnóstico. La radiología se emplea para diagnóstico diferencial y documentación. La técnica de Moschowitz fue la empleada para reconstruir ese fondo de saco anormalmente profundo. No existió morbi-mortalidad intra ni post operatoria. El seguimiento se logró en 17 pacientes, y el tiempo del mismo osciló entre los 4 meses y los 20 años. Dieciseis de ellos tuvieron resultados satisfactorios con desaparición de los síntomas de bloqueo rectal

Bloqueo rectal por fondo de saco rectogenital profundo: nuestra experiencia / Deep pouch of Douglas: a series of 20 cases

La persistencia de un fondo de saco de Douglas profundo es, en algunos casos, un factor de constipación, manifestado como dificultad para lograr la evacuación rectal. Se analizan retrospectivamente los resultados obtenidos con la resolución operatoria de 20 pacientes del sexo femenino y que fueron intervenidas entre los años 1974 y 1995, portadoras de fondo de saco de Douglas profundo. La edad promedio era de 58 años (rango 24-83 años). Se enfatiza en la importancia del interrogatorio para establecer el diagnóstico. La radiología se emplea para diagnóstico diferencial y documentación. La técnica de Moschowitz fue la empleada para reconstruir ese fondo de saco anormalmente profundo. No existió morbi-mortalidad intra ni post operatoria. El seguimiento se logró en 17 pacientes, y el tiempo del mismo osciló entre los 4 meses y los 20 años. Dieciseis de ellos tuvieron resultados satisfactorios con desaparición de los síntomas de bloqueo rectal (AU)