Ultrasound in the Evaluation of Pouch of Douglas Obliteration

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. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Khong SY, Bignardi T, Luscombe G, Lam A. Is pouch of Douglas obliteration a marker of bowel endometriosis? J Minim Invasive Gynecol. 2011;18(3):333–7. Reid S, Lu C, Condous G. Can we improve the prediction of pouch of Douglas obliteration in women with suspected endometriosis using ultrasound based models? A multicenter prospective observational study. Acta Obstet Gynecol Scand. 2015;94(12):1297–306. Shakeri B, Nadim B, Reid S, Martins WP Condous G OP34.04: Accuracy of different imaging techniques to assess POD obliteration: a systematic review and meta-analysis. In: Gynecol UO, editor. 26th World Congress on Ultrasound in Obstetrics and Gynaecology; September 2016; Rome. 2016. p. 165. Reid S, Lu C, Casikar I, Reid G, Abbott J, Cario G, et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol. 2013;41(6):685–91. Epub 2012/09/25 Reid S, Lu C, Casikar I, Mein B, Magotti R, Ludlow J, et al. The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound ‘sliding sign’ technique: inter- and intra-observer reproducibility. Hum Reprod. 2013.; Epub 2013/03/14 Tammaa A, Fritzer N, Strunk G, Krell A, Salzer H, Hudelist G. Learning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum. Hum Reprod. 2014;29(6):1199–204. Epub 2014/04/30 Piessens S, Healey M, Maher P, Tsaltas J, Rombauts L. Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Aust N Z J Obstet Gynaecol. 2014;54(5):462–8. Epub 2014/10/08 Hudelist G, Fritzer N, Staettner S, Tammaa A, Tinelli A, Sparic R, et al. Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol. 2013;41(6):692–5. Epub 2013/02/13 Guerriero SCG, Van den Bosch T, Valentin L, Leone F, Van Schoubroeck D, Exacoustos C, AJF I, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar J, Gonçalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to evaluate the pelvis in women with suspected endometriosis including terms, definitions and measurements to describe the sonographic features of deep infiltrating endometriosis: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318–32. Author information Authors and Affiliations Editor information Editors and Affiliations 7.1 Electronic Supplementary Material (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) (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) (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) (MP4 3290 kb) Rights and permissions Copyright information © 2018 Springer International Publishing AG, part of Springer Nature About this chapter Cite this chapter Reid, S. (2018). Ultrasound in the Evaluation of Pouch of Douglas Obliteration. In: Guerriero, S., Condous, G., Alcázar, J.L. (eds) How to Perform Ultrasonography in Endometriosis. Springer, Cham. https://doi.org/10.1007/978-3-319-71138-6_7 Download citation DOI: https://doi.org/10.1007/978-3-319-71138-6_7 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-71137-9 Online ISBN: 978-3-319-71138-6 eBook Packages: MedicineMedicine (R0)