Cul-de-sac liquid should always be evaluate at the moment of a transvaginal ultrasound, as the findings are often helpful in supporting a diagnosis.
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The female pelvis is a complex and ever-changing area the the human body, and the pouch of Douglas is a certain area of contrasts. Additionally known as the cul-de-sac, the bag of Douglas exists in between the uterus and also the rectum, and it is the many dependent area that the pelvis, whereby fluids pool.
Physiologic and also pathologic cul-de-sac liquid takes many forms. Expression blood that has refluxed v the fallopian tubes and fluids regarded ovulation or ruptured cysts work out in it. Likewise, blood from a ruptured ectopic pregnancy, inflammatory debris from a pelvic or appendiceal infection and ascites as result of malignancy, liver or cardiac failure may collect here. The amount might be copious or just a tiny bit the is provided on regimen ultrasound evaluation.
Transvaginal ultrasound image of little amount of liquid in cul-de-sac (arrow)
What Is the bag of Douglas?
The area in inquiry is positioned in nearby proximity come the posterior quality fornix, which offers a potential keyhole for access to the pelvic cavity. Diagnostic culdocentesis, drainage that cul-de-sac fluid collections and also abscesses, and biopsies the pelvic cul-de-sac masses are examples of procedures that can be performed. Also minimally invasive actions, such as egg retrievals for IVF or bilateral tubal ligations, have actually been accomplished via this route. With the breakthrough and advance of ultrasound technology, the assessment of the type and quantity of fluid in the bag of Douglas has actually improved our capacity to categorize what"s discovered there. At the same time, 3D ultrasound has thankfully reduced the number of invasive and also often painful procedures performed via the posterior quality fornix.
This small, look at insignificant and also shapeless space was called after one esteemed 18th-century Scottish physician and anatomist who lived in London and cared for women throughout childbirth. Dr. James Douglas to be the queen"s personal doctor. He additionally performed dissections in his home and also published his findings and also observations on a broad range of subjects. His enduring papers and also anatomic drawings are preserved at the college of Glasgow and also his immortality assured with numerous anatomic landmarks transferring his name, consisting of the bag of Douglas.
What to Look for in the pouch of Douglas
Studies published in 1982 in Radiology and in 1998 in the journal of Ultrasound in medication demonstrated the echogenic masses and also cul-de-sac fluid on transvaginal ultrasound are very predictive of the detect of clotted blood and also hemoperitoneum. Inflammation effusions have the right to have a variety of ultrasound features relying on the phase of the condition process. The exploration of filmy adhesions in the cul-de-sac liquid is suggestive the a previous or chronic infection. A full urinary bladder might displace pelvic liquid out the the pouch of Douglas. This might lead come the mistaken diagnosis that ascites, which would have far-reaching clinical implications.
Increased amount of fluid in pelvis
The ultrasound meaning of ascites has been described as fluid filling the pouch of Douglas and extending past the fundus of the uterus. A better definition or actual quantification the the liquid is required as the dimension of a uterus different from separation, personal, instance to individual. In 2010, a study published in the journal Ultrasound in Obstetrics & Gynecology determined that patience height and weight did no appreciably influence the calculation of pelvic liquid volumes up to 1 liter. Dimensions of the largest pocket of fluid were taken in 3 planes: height, length and depth. If the fluid surrounded the uterus and also was found anterior and also superior to the uterus as well, the volume the the uterus was calculated and also subtracted from the measurement of the liquid pocket.
The study determined that the measurements of fluid volumes associated with the amount of fluid instilled in the patient during the study and also were reproducible. On the other hand, the absence of fluid in the bag of Douglas may likewise have clinical significance. Because that example, in a patient with endometriosis, an obliterated cul-de-sac secondary to agglutination the the peritoneal surfaces from scarring led to by infiltrating endometriosis will prevent liquid from pooling here.
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The pouch of Douglas should always be evaluated at the time of a transvaginal ultrasound, together the findings room often helpful in supporting a pelvic pains diagnosis. Because fluid indigenous the pouch of Douglas protects the body from contamination, checking it on transvaginal ultrasound is vital.