The scan revealed the presence of a cornual anechoic mass with a hyperechoic border, compatible with tubal ring in the interstitial portion of the right tube, with maximum diameter of 0,87 cm, (Figure 4) and no free fluid in the
pouch of Douglas. At admission, serum [beta]-hCG level was 3212 UI/L.
Moreover, seeing as her abdominal pain was accompanied by fever, raised inflammatory markers, intermenstrual bleeding, and "complex", free fluid in the
pouch of Douglas, a diagnosis of PID was readily made.
Prediction of
pouch of Douglas Obliteration in women with suspected endometriosis using a new real time dynamic transvaginal ultrasound technique: the sliding sign.
It affects approximately 10 Percent females and commonly presents in the ovaries, uterosacral ligament,
pouch of Douglas and pelvic peritoneum, while, the rare sites of endometriosis include intestine, bladder, surgical scars, umbilicus6, diaphragm7, and groin8.
Are these patient's symptoms due to pelvic organ prolapse or
Pouch of Douglas hernia?
On review by the gynaecologist, clinical examination revealed a normal lower genital tract and cervix with a 12-14cm right adnexial mass and no involvement of the
pouch of douglas. A transabdominal and transvaginal ultrasound scan was requested which revealed a 12 cm complex right ovarian cyst with a 3 cm daughter cyst.
The largest dimension of these lesions is located under the peritoneal fold of the rectouterine
pouch of Douglas. The cranial movement of these posterior fornix lesions eventually causes the nodules to join the anterior rectal wall and creates an "hourglass"-like appearance.
Gynecologic examination showed greenish, purulent vaginal discharge and a fluctuant mass in the
pouch of Douglas. Uterine cervical motion caused pain to the patient.
There was significant correlation between the site of the tenderness on TVS and that of endometriosis on laparoscopy (right adnexa/ovary, left adnexa/ovary, and
pouch of Douglas), with an odds ratio of 1.3.
(1) The
Pouch of Douglas (POD) is the most common location of abdominal pregnancy followed by the mesosalpinx and omentum.
Fluid and "sliding sign" were shown in the
Pouch of Douglas. At laparoscopy, two voluminous adnexal masses, measuring about 7 cm, with exophytic vegetation and superficial vascularization, were seen bilaterally.