Pelvic peritoneum Image

 

   Rectovesical pouch

Peritoneum coveing the bladder

Sigmoid colon

PELVIC PERITONEUM

This is a unique peritoneum because it lines structures in the lesser pelvis. The pelvic fascia is placed underneath the peritoneal lining, which is parietal peritoneum. The pelvic peritoneum may be said to begin at the superior border of the pubic symphysis. It then turns on the superior surface of the urinary bladder where it forms paravesical fossae.

Male:

It continues backwards in the male to dip between the urinary bladder and rectum by forming a wide rectovesical pouch. The peritoneum lines the back of the seminal vesicle and the prostate gland but does not invest them. It then sweeps upwards and backwards to plaster the rectum to the hollow of sacrum. From the rectum, it joins the parietal peritoneum of the posterior abdominal wall at the level of the 3rd piece of the sacrum.

 

Female:

The peritoneum which lines the superior surface of the urinary bladder proceeds backwards to form a pouch between that structure and the uterus called the uterovesical pouch of peritoneum. This peritoneum covers the superior aspect of the supravaginal cervix and can be approached from the anterior fornix of vagina. It continues on the superior aspect of the fundus of the uterus and then gains the back of that organ to form another pouch between it in the rectum, called the rectouterine pouch of Douglas. This pouch is more inferior than the anterior pouch.

It is immediately related to the posterior fornix of vagina and hence allows easy access to the pouch from the posterior fornix in a procedure called culdotomy or culdoscentesis (the pouch of Douglas is called cul-de-sac.

Whatever be the case, it can provide valuable information as to the state of pelvic structures in the female where a tap may produce blood, (suggesting internal haemorrhage), pus (abscess collection) or fluid (ascites) etc. Also a posterior culpotomy can be performed through the posterior fornix of the vagina, just like an anterior culpotomy would be opening into the peritoneum through the anterior fornix of vagina.

Pelvic fascia

Underneath the parietal peritoneum, which covers the superior and posterior surfaces of the pelvic viscera, we have the pelvic fascia which can be further divided into

  • Parietal  fascia- this covers the pelvic wall and the surfaces of the levator ani or pelvic floor and that of the obturator internus. It is pelvic fascia proper.

  • Visceral fascia. This is the endopelvic fascia. It is the extraperitoneal cellular tissue that covers the urinary bladder, rectum and vagina. They form ligament to anchor the cervix, uterus and vagina to the pelvic wall. See Uterus.

Pelvic fascia in general covers organs, the pelvic wall and the pelvic floor but avoids bones except at the fascia of Waldeyer which is attached to the hollow of sacrum.

Others

Lymphatics

 

  • Embryology

  • Histology

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Exposure of pelvic cavity

 

 

 

 

 

 

Male pelvic peritoneum

1 pelvic peritoneum 2 urinary bladder 3 seminal vesicle 4 rectum

 

 

 

 

Pelvic peritoneum in female

1 rectum 2 anus 3 uterus 4 urinary bladder 5 vagina 6 pelvic peritoneum (green)