Rectovesical Pouch

excavatio rectovesicalis

The rectovesical pouch is the deepest peritoneal reflection in males, lying between the posterior bladder and the anterior rectum. It is the most dependent pelvic peritoneal space in the supine male and is where free fluid, pus, and metastatic implants accumulate preferentially. In females the equivalent space is divided by the uterus into the vesicouterine and rectouterine (Pouch of Douglas) pouches.

Region: Abdomen

Clinical Relevance

Clinical Notes

Free fluid in the rectovesical pouch on FAST ultrasound or CT indicates pelvic organ injury or peritonitis. Peritoneal metastases preferentially seed this dependent recess and are evaluated by peritoneal cytology during robot-assisted radical prostatectomy. Endoscopic ultrasound accesses the rectovesical pouch via the rectum for posterior pelvic biopsy. Laparoscopic drainage of pelvic abscess targets this recess.

Pathology

Common Injuries & Conditions

Rectovesical Pouch Abscess

Localised pelvic peritonitis in the rectovesical pouch from perforated diverticulitis, appendicitis, or post-surgical infection, producing fever, pelvic pain, and a tender pelvic mass, managed by CT-guided or surgical drainage.