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Ultrasound in Assisted Reproductive Technology: Anatomy and Core Examination Skills
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Finally, to conclude the examination, the pouch of Douglas (cul-de-sac) is examined by noting the following: Identify the pouch of Douglas or the rectouterine pouch, an extension of the peritoneal cavity between the rectum and back wall of the uterus, cervix, and upper vagina.Examine fully from one side of the pelvis to the other.Note any fluid collection, adhesions, endometriotic deposits, loops of bowel, or any other solid or cystic masses. A small amount of fluid is normally present around the time of ovulation and not infrequently.
Anatomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Ernest F. Talarico, Jalid Sehouli, Giuseppe Del Priore, Werner Lichtenegger
The rectouterine pouch opens laterally into the pararectal space (Moore et al. 2014). After being opened from the abdomen, the pararectal space is narrow, because the rectal pillar lies close to the pelvic wall. Surgeons can gain access to this space pulling the uterus anteriorly so that the rectal pillar is lifted off the pelvic wall.
Pelvis and perineum
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
The junction of the rectum and anal canal is marked by the palpable anorectal ring produced by the sling of the puborectalis muscle. The lowest part of the peritoneal cavity (rectovesical or recto-uterine pouch) is in reach of the fingertip during rectal examination.
Management of mucocele of the appendix with peritoneal dissemination in pregnant women: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Sophiane Derbal, Clemence Klapczynski, Aurélie Charissoux, Sylvaine Durand Fontanier, Abdelkader Taibi
In pregnant women with AM, it is important to distinguish two situations (Figures 2 and 3). First, the management of AM discovered intraoperatively in a pregnant woman does not differ from that in the general population. The abdominal cavity is explored, and peritoneal nodules and/or mucin are systematically removed. The PCI should then be calculated as this will guide further treatment. The principles of surgery include resection of the appendix, wide resection of the mesoappendix and complete evacuation of the intraperitoneal mucoid material [6]. Mucin deposits in AM may be acellular or contain a neoplastic epithelium [9]. A challenge in pregnant women is the exploration of the ovaries as well as the rectouterine pouch or right para-colic gutter, which are preferential areas of mucus accumulation. In our patient, the surgeon carefully performed an appendectomy that included the meso-appendix. A laparoscopic approach is possible only if the surgeon uses the ‘no touch tumour’ technique, to avoid perforation of the tumour. Otherwise, a conversion to laparotomy is necessary and the appendectomy is performed according to the same principle. Macroscopic involvement of the appendiceal base requires ileocecal resection or right hemi-colectomy (more to obtain a macroscopically complete resection and adequate lymph node dissection. The main risk of AM is progression to PMP.
Immature teratoma of the uterine cervix
Published in Journal of Obstetrics and Gynaecology, 2022
Manizheh Sayyah-Melli, Behrouz Shokohi, Shabnam Yagoobi, Ali Adili, Seyyedeh Sanaz Hosseini
Teratomas usually arise in the gonads and mainly develop in midline structures; and, extragonadal types of teratomas are infrequent (Kurman et al. 2011). (Oosterhuis et al. 2007; Misra et al. 2014). Cervical teratoma, is relatively rare (Oosterhuis et al. 2007). It is suggested that this type of tumour in the cervix and endometrium may be originated from residual foetal tissue. To our knowledge, there have been a few uterine cervical immature teratoma cases reported in the literature to date. In contrast to our case, which was presented with pelvic pressure, constipation and report of a leiomyoma behind the cervix, all reported cases had originated from the cervical canal with abnormal vaginal bleeding (AUB) (Cortes et al. 1990; Panesar and Sidhu 2007; Ito et al. 2019) (Cortes et al. 1990) (Panesar and Sidhu 2007), or the uterine fundus (Iwanaga et al. 1993; Gomez-Lobo and Burch 2008; Souza et al. 2014). In this case, the patient had no AUB. Another case reported by F Khorsandi showed a solid tumour of the left corner of the external os (Khorsandi and Anabitarte 1981). In contrast to the study of Simona Stolnicu and colleagues, in which immature solid teratomas involved uterine corpus, ovary and mature teratomas, the cervix and para-uterine tissue, in our study, the ovaries looked normal (Stolnicu et al. 2017). There was also differences between our study and the study of Zamani et al. In this study, the authors reported a necrotised mature teratoma of the uterus with aggressive behaviour (Zamani et al. 2018). In contrast, our case originated from the posterior surface of the cervix progressed to the recto-uterine pouch, parametrium and pelvic sidewall.
Management of relapsed ovarian cancer in routine clinical practice: a case study
Published in Expert Review of Anticancer Therapy, 2018
In February 2013 after 6 cycles, debulking surgery was performed involving hysterectomy, bilateral anexectomies, and infragastric omentectomy. Multiple biopsies were taken which were positive for the ileum, mesentery, colon, and recto-uterine pouch, and negative for the diaphragm and paracolic gutters. The surgeon classified the disease as stage CC0.