Rectovesical pouch !

The rectovesical pouch is the space between the bladder and the rectum in men, the lowest point of the abdomen; fluid, blood or pus collects here first.

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What it is

The lowest point of the male peritoneal cavity: a fold of peritoneum between the bladder (with the seminal vesicles) and the rectum.

What it does

Fluid, blood or pus in the abdomen collects here first, so it is checked on ultrasound; cancer deposits can settle here and may be felt on a rectal examination.

Key facts

Where: Lowest point of the male peritoneal cavity, between the rectum behind and the bladder and seminal vesicles in front; male counterpart of the rectouterine pouch
Attaches: Peritoneum reflected from the front of the upper rectum onto the back of the bladder and the tips of the seminal vesicles; below it, the rectoprostatic (Denonvilliers) fascia
Function: Collects free fluid, blood or pus (pelvic abscess), checked on FAST ultrasound; drop metastases here form a shelf (Blumer) felt on rectal examination

Relations

In front: Urinary bladder and the tips of the seminal vesicles and ampullae of the ductus deferens
Behind: Upper and middle rectum
Lateral: Peritoneal folds running back from the bladder to the sides of the rectum (rectovesical folds)
Below: Rectoprostatic (Denonvilliers) fascia, between the rectum and the prostate and seminal vesicles below the peritoneum
Contents: Normally loops of small bowel or sigmoid colon; in disease, fluid, blood, pus or tumour deposits

How to find it

On digital rectal examination its floor lies at the upper reach of the finger, above the prostate; tenderness or a mass there may reflect an abscess or deposits.

On imaging

On ultrasound through a full bladder or on CT, free fluid appears behind the bladder first; CT and MRI show pelvic abscesses and peritoneal deposits here.

How it is diagnosed

Ultrasound or CT scan.

Clinical notes

Some laparoscopic prostatectomy techniques open the peritoneum here first to reach the seminal vesicles from behind
It is the lowest part of the peritoneal cavity in an upright man, so blood or fluid from the abdomen pools here; the pelvic view of a FAST scan looks for it behind the bladder
Peritoneal metastases, for example from stomach cancer, can settle here and be felt on rectal examination as a hard shelf above the prostate (Blumer shelf)

Test yourself

Think of the answer, then tap the question to see it.

What is the lowest point of the male peritoneal cavity?

The rectovesical pouch, between the rectum and the bladder with the seminal vesicles; male counterpart of the rectouterine pouch.

How does a pelvic abscess in the rectovesical pouch present?

Rectal fullness, mucus diarrhoea and a tender bulge felt on rectal examination; it can be drained through the rectal wall or under imaging.

What is a Blumer shelf in the male?

Drop metastases in the rectovesical pouch forming a shelf felt on rectal examination, above the prostate.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): excavatio rectovesicalis
Official Spanish (DeCS): Fondo de saco rectovesical
English (TA2): Rectovesical pouch

Sources: Anatomy, Abdomen and Pelvis, Rectum; Anatomy, Abdomen and Pelvis, Peritoneum.

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Representative model, for educational purposes only.