Vesicouterine Pouch

excavatio vesicouterina

The vesicouterine pouch is the peritoneal reflection between the posterior bladder and the anterior uterus in females, forming the most anterior of the two pelvic peritoneal recesses. It is shallower than the rectouterine pouch and is obliterated in lower uterine segment cesarean section where the peritoneum is reflected to access the uterine isthmus.

Region: Abdomen

Clinical Relevance

Clinical Notes

The vesicouterine pouch is entered in cesarean section to reflect the bladder inferiorly and expose the lower uterine segment. Adhesions in this pouch from prior cesarean sections create the densely adherent bladder flap that increases the risk of bladder injury in repeat cesarean sections. Ectopic pregnancy in the vesicouterine pouch (cervicovesical ectopic) is a rare but life-threatening condition. Endometriosis in this pouch causes bladder involvement.

Pathology

Common Injuries & Conditions

Vesicouterine Adhesions

Peritoneal fusion in the vesicouterine pouch from prior cesarean section creating a dense bladder flap adherent to the lower uterine segment, increasing bladder injury risk in subsequent pelvic surgery.