Liquid in the Douglas space | Douglas space

Liquid in the Douglas space

Fluid in the Douglas cavity is a common finding in women and can have very different causes. Because the Douglas cavity is the deepest point within the peritoneum, all free fluids of the abdominal cavity collect there when standing or sitting. This does not necessarily mean that there is a disease behind it and not every accumulation of fluid needs to be treated. However, the physician should carry out examinations with each accumulation of fluid to rule out a disease. In some cases, a harmless cyst that produces fluid is the cause.

Puncture of the Douglas space

During a puncture, the physician inserts an elongated hollow needle into the area to be examined and, if available, sucks in fluid. The liquid obtained is called puncture fluid. This fluid can then be examined in detail in the medical laboratory for its components.

A puncture is carried out to clarify fluid accumulations and to make a more precise diagnosis. The Douglas cavity is not too easy to reach from the outside, which is why a puncture is performed through the vagina or rectum, but sometimes also through the abdominal wall. In men the room can only be reached directly through the rectum.

In order to be able to puncture more precisely, the procedure is controlled by means of CT recording. With the help of the puncture, a specific pathogen can be identified in case of inflammation, which can be targeted for therapy and antibiotic treatment. If malignant cells are suspected to be present in the abdomen (as part of a tumor disease), they can also be determined by punctate.

If there is bleeding in the abdomen, it can be diagnosed by puncturing the Douglas cavity. A puncture can also be used to flush and clean the Douglas cavity with fluid if it is affected by inflammation. A puncture is usually performed without any consequences and under local anesthesia.

Diseases affecting the Douglas space

• Ignition
• Cyst
• Endometriosis
• Tumor

Inflammation in the Douglas cavity can occur when the mucous membrane there comes into contact with germs. This is especially the case with peritonitis. Such peritonitis is caused by the carry-over of bacteria, viruses and other pathogens into the abdominal cavity.

Rarely is a generalized infection of the body the cause. More often the bacteria enter the peritoneal cavity through a damaged intestine, for example. In the case of perforations, the bacteria, which are otherwise only located within the gastrointestinal tube, are released.

As a result of intestinal inflammation, such as appendicitis or diseases such as Crohn’s disease or ulcerative colitis, perforations of the intestinal wall can occur. Operations on the abdomen can also lead to the spread of germs. The result is a purulent inflammation of the peritoneum, whose purulent fluid accumulates in the Douglas cavity.

The fluid can become encapsulated there and form an inflammatory abscess. Abdominal pain (especially during bowel movements) and fever are a frequent consequence. Inflammations in the small pelvis can also migrate into the Douglas cavity.

The outer wall of the uterus, as well as the fallopian tubes and ovaries, are particularly affected.The diseases known as “perimetritis” and “pelvic inflammatory disease” often form secretory accumulations and abscesses in the Douglas cavity due to their proximity. Ultrasound, blood and puncture examinations can be used to make a diagnosis. These inflammations can be treated with medication or surgery.

Do the self-test: Pain in the abdomen – What do I have? The term cyst is used to describe a cavity enclosed by an epithelium. It can be filled with different liquids, pus or air.

Cysts in the Douglas cavity usually form on the ovaries. These are usually benign and do not require any therapy. A cyst can form on the ovaries mainly as a result of hormonal stimulation by the menstrual cycle.

This is called a functional cyst. A disturbed hormone balance seems to increase the formation of cysts on the ovaries. Non-functional uterine cysts are a series of cysts of different, non-hormonal causes.

Since some types can be dangerous, a cyst in the Douglas cavity requires medical clarification. Tumors can be benign or malignant. A malignant tumor can form metastases, i.e. small metastases of its origin in foreign tissue.

Tumors of the gastrointestinal tract form a large group of all cancers. They and other tumors of the abdominal cavity, for example those of the ovaries, liver or pancreas, can form metastases in the peritoneum. If this is the case, one speaks of “peritoneal carcinomatosis”.

This spread of the cancer cells occurs via the bloodstream or directly within the abdominal cavity via detachment of the tumor cells and contact with the inner abdominal wall. The so-called “Krukenberg tumor” refers to the infestation of the Douglas cavity with tumor cells, which in most cases originate from a seal-ring cell carcinoma of the stomach. With the help of a puncture and a subsequent cytological examination, the malignant cells in the Douglas cavity can be identified and the suspicion of peritoneal carcinomatosis confirmed.

Other tumors that may spread into the Douglas cavity originate from the woman’s ovary or the endometrium, the mucous membrane layer of the uterus. The endometriosis located in the Douglas cavity, which affects many women, can also be a precursor of carcinoma in some cases. Endometriosis is a common chronic disease that can occur in women.

It involves the colonization of cells of the endometrium not inside the uterus but outside it. In affected women, this can lead to severe lower abdominal pain, especially during menstruation. It is not a malignant change, but in many cases it can also lead to infertility.

In extreme cases, adhesions in the abdominal cavity must be removed by surgery to prevent possible subsequent organ changes. A woman’s Douglas cavity is the deepest point of the abdominal cavity when standing. It is also known as the rectouterine cavity.

It represents a depression between the rectum and the uterus. If endometriosis occurs in the Douglas cavity, additional pain can therefore occur during bowel movements or sexual intercourse. The cause of endometriosis in the Douglas cavity is suspected to be a transfer of mucosal cells via the female fallopian tubes into the lower abdominal cavity.

Endometriosis in the Douglas cavity is most likely to affect a woman’s fertility. Due to adhesions within the Douglas cavity, the absorption of the cracked egg from the ovary into the fallopian tube is disturbed, so that the egg cannot enter the fallopian tube and thus fertilization by sperm cannot take place. There are also other causes that can lead to infertility in a woman through endometriosis.

For example, endometriosis quickly causes the uterus to become overactive, which means that the sperm that enter the fallopian tube during sexual intercourse have a shorter duration of stay, thus significantly reducing the probability of fertilisation of the egg. This may also be of interest to you in this respect: Causes of infertility Another cause of a woman’s possible infertility can be an inflammation caused by endometriosis, which in turn causes chronic irritation of the abdominal cavity. This leads to adhesions within the fallopian tube, so that the cracked egg can no longer reach the uterus.

One possible therapy is the surgical removal of ovarian cysts and adhesions within the abdominal cavity. If the operation is successful, it is very likely that the fertility of a woman can be increased.