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Ultrasound in the Evaluation of Pouch of Douglas Obliteration

  • Shannon Reid

Abstract

The pouch of Douglas (POD) is described as the region of peritoneum which occupies the deepest part of the female pelvis and is located between the lower posterior cervix and the anterior rectum. Complete POD obliteration is described when this area of peritoneum between the posterior cervix and anterior rectum is no longer visible due to adhesions or scarring in the POD. POD obliteration is most commonly associated with adhesions between the anterior rectum and posterior cervix and/or between the rectosigmoid bowel and posterior uterine fundus. Adhesions in the POD are often caused by an underlying DE nodule, but may also be caused by scarring in the POD from pelvic inflammatory disease, previous surgery, or extensive ovarian/peritoneal endometriosis. Adhesions may also form unilaterally in the POD, between a structure containing a DE nodule and adjacent structure(s) (i.e., uterosacral ligament (USL) and anterior rectum). In this case, a portion of the POD may remain visible (i.e., contain normal peritoneum), and this situation is known as partial or unilateral POD obliteration.

Supplementary material

Video 7.1

(a) Transvaginal ultrasound is used to demonstrate a positive “sliding sign” between the anterior rectum and posterior uterine cervix/retro-cervix (C) in the sagittal plane. POD = pouch of Douglas. (b) Transvaginal ultrasound is used to demonstrate a positive “sliding sign” between the rectosigmoid bowel and posterior uterine fundus (U) in the sagittal plane (MP4 9977 kb) (MP4 9977 kb)

Video 7.2

(a) Transvaginal ultrasound is used to demonstrate a negative “sliding sign” between the anterior rectum (R) and posterior uterine cervix/retro-cervix (C) in the sagittal plane. (b) Transvaginal ultrasound is used to demonstrate a negative “sliding sign” between the rectosigmoid bowel (RS) and posterior uterine fundus (U) in the sagittal plane (MP4 17,600 kb) (MP4 17600 kb)

Video 7.3

(a and b) Transvaginal ultrasound is used to demonstrate a positive “sliding sign” for a retroverted uterus, at both the posterior uterine fundus and anterior lower uterine segment, respectively (sagittal plane). In Video 3a, the anterior rectum glides freely over the posterior uterine fundus. In Video 3b, the rectosigmoid bowel glides freely over the anterior lower uterine segment. U uterus (MP4 7486 kb) (MP4 7486 kb)

Video 7.4

(MP4 3290 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Shannon Reid
    • 1
  1. 1.Department of Obstetrics and GynaecologyLiverpool HospitalSydneyAustralia

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