Cul-de-sac liquid should always be evaluated at the moment of a transvaginal ultrasound, together the findings room often useful in supporting a diagnosis.

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The female pelvis is a facility and ever-changing area of the human being body, and the pouch of Douglas is a specific area the contrasts. Likewise known together the cul-de-sac, the pouch of Douglas exists between the uterus and the rectum, and also it is the many dependent area of the pelvis, where fluids pool.

Physiologic and also pathologic cul-de-sac fluid takes countless forms. Expression blood that has actually refluxed through the fallopian tubes and fluids related to ovulation or ruptured cysts resolve in it. Likewise, blood from a ruptured ectopic pregnancy, inflammation debris from a pelvic or appendiceal infection and also ascites because of malignancy, liver or cardiac failure might collect here. The amount might be copious or just a tiny bit the is detailed on program ultrasound evaluation.

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Transvaginal ultrasound picture of little amount of fluid in cul-de-sac (arrow)

What Is the bag of Douglas?

The area in question is located in nearby proximity to the posterior quality fornix, which provides a potential keyhole for accessibility to the pelvic cavity. Diagnostic culdocentesis, drainage of cul-de-sac fluid collections and also abscesses, and biopsies that pelvic cul-de-sac masses are examples of steps that deserve to be performed. Even minimally invasive actions, such together egg retrievals for IVF or bilateral tubal ligations, have been achieved via this route. Through the advance and breakthrough of ultrasound technology, the evaluate of the type and quantity of fluid in the bag of Douglas has improved our capacity to categorize what"s discovered there. In ~ the very same time, 3D ultrasound has actually thankfully lessened the variety of invasive and also often painful measures performed via the posterior quality fornix.

This small, look at insignificant and shapeless room was named after an esteemed 18th-century Scottish physician and also anatomist who lived in London and also cared for women throughout childbirth. Dr. James Douglas to be the queen"s an individual doctor. He additionally performed dissections in his home and published his findings and also observations top top a broad range of subjects. His surviving papers and also anatomic drawings are maintained at the college of Glasgow and also his immortality assured with number of anatomic landmarks carrying his name, including the bag of Douglas.

What to Look for in the bag of Douglas

Studies released 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 highly predictive of the finding of clotted blood and hemoperitoneum. Inflammation effusions deserve to have a range of ultrasound features relying on the stage of the condition process. The exploration of filmy adhesions in the cul-de-sac fluid is suggestive of a past or chronic infection. A full urinary bladder may displace pelvic fluid out of the pouch of Douglas. This can lead come the failure diagnosis that ascites, which would have significant clinical implications.

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Increased quantity of fluid in pelvis

The ultrasound meaning of ascites has been explained as fluid filling the bag of Douglas and also extending beyond the fundus of the uterus. A better definition or actual quantification that the liquid is required as the dimension of a uterus varies from individual to individual. In 2010, a study published in the journal Ultrasound in Obstetrics & Gynecology established that patience height and also weight did not appreciably affect the calculate of pelvic fluid volumes as much as 1 liter. Dimensions of the largest pocket of liquid were taken in three planes: height, length and depth. If the liquid surrounded the uterus and was discovered anterior and superior to the uterus as well, the volume the the uterus to be calculated and subtracted native the measure up of the liquid pocket.

The study figured out that the dimensions of liquid volumes correlated with the quantity of fluid instilled in the patient during the study and were reproducible. On the various other hand, the lack of fluid in the pouch of Douglas may also have clinical significance. Because that example, in a patient v endometriosis, one obliterated cul-de-sac an additional to agglutination that the peritoneal surfaces from scarring led to by infiltrating endometriosis will prevent fluid from pooling here.

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The bag of Douglas should constantly be evaluated at the time of a transvaginal ultrasound, as the findings are often advantageous in sustaining a pelvic ache diagnosis. Since fluid indigenous the pouch of Douglas protects the human body from contamination, checking it on transvaginal ultrasound is vital.