Tiers of the lesser pelvis cavity
Anatomically, the lesser pelvis cavity is conventionally divided into three isolated compartments (tiers):
- Peritoneal compartment (cavum pelvis peritoneale) — the upper tier, containing parts of organs covered by the peritoneum.
- Subperitoneal compartment (cavum pelvis subperitoneale) — the middle tier, housing the extraperitoneally located parts of organs and neurovascular structures.
- Subcutaneous compartment (cavum pelvis subcutaneum) — the lowest tier of the perineum.
Peritoneal reflection in males
From the anterior abdominal wall, the peritoneum extends onto the superior, partially posterior, and lateral walls of the urinary bladder. Near the pubic symphysis, it forms the plica vesicalis transversa (transverse vesical fold), which smooths out as the organ fills.
Having passed the posterior wall of the urinary bladder, the peritoneum covers the ampullae of the vas deferens (ampullae ductus deferentis) and the tips of the seminal vesicles, falling short of the base of the prostate gland by approximately 1.0–1.5 cm. As the peritoneum transitions from the urinary bladder to the rectum, it forms the rectovesical pouch (excavatio rectovesicalis). This is the lowest point of the male pelvic peritoneal cavity, bounded laterally by the rectovesical folds (plicae rectovesicales) and fixed to the Denonvilliers-Salishchev fascia.
Peritoneal reflection in females
In females, the topography of the peritoneum is more complex due to the presence of the uterus:
- From the urinary bladder, the peritoneum reflects onto the anterior surface of the uterus at the level of its isthmus, forming the shallow vesicouterine pouch (excavatio vesicouterina).
- After enclosing the uterus, the peritoneum descends below its cervix, covers the posterior vaginal fornix (fornix vaginae posterior), and continues onto the rectum.
- This forms the deep rectouterine pouch (excavatio rectouterina), also known as the pouch of Douglas.
- On the sides, this pouch is bounded by the rectouterine folds (plicae rectouterinae), which contain fibromuscular ligaments.
Clinical significance of pelvic recesses
The anatomical arrangement of the peritoneal pouches determines their role in the development of pathologies and medical procedures:
- Fluid accumulation: Inflammatory exudate, blood from trauma or ectopic pregnancy, and abscesses can accumulate in the rectovesical pouch in males and the pouch of Douglas in females.
- Vaginal access: Because the pouch of Douglas lies adjacent to the posterior vaginal fornix, this area is used for diagnostic paracentesis (evaluating fluid characteristics) and colpotomy (incision for content drainage).
Briefly: answers to topical questions
What specific structures are contained within the rectouterine folds in females?
The rectouterine folds (plicae rectouterinae) in females contain fibromuscular bands. The contents of these folds include:
- Rectouterine ligament (lig. rectouterinum) — plays an important role in anchoring the uterus.
- Sacrouterine ligament (lig. sacrouterinum) — also forms part of the supporting apparatus.
These structures overlie the rectouterine pouch, partially isolating it from the general lesser pelvis cavity, and extend all the way to the anterior surface of the sacrum.
Which blood vessels and nerve plexuses are located in the subperitoneal compartment (cavum pelvis subperitoneale) of the lesser pelvis?
According to sources, the following neurovascular structures are located or course within the subperitoneal compartment of the pelvis:
- Pelvic nerve trunks and vessels — located laterally to the pelvic ureters on the lateral pelvic wall.
- Obturator neurovascular bundle — crossed by the ureters as they course toward the base of the urinary bladder.
- Origin of the umbilical artery — also crossed by the ureters.
- Inferior hypogastric, or pelvic, plexus (plexus hypogastricus inferior / plexus pelvinus) — an autonomic plexus shaped like a plate extending from the sacrum to the urinary bladder.
- Common lymphatic plexus — located beneath the peritoneum of the rectouterine pouch.
In males, the peritoneum stops short of the prostate by 1–1.5 cm, whereas in females it descends below the cervix directly onto the posterior vaginal fornix, forming the deep pouch of Douglas.
Class and exam questions
Which structure represents the lowest point of the male pelvic cavity?
The lowest point is the rectovesical pouch (excavatio rectovesicalis), the floor of which is fixed to the Denonvilliers-Salishchev fascia.
What is the clinical significance of the posterior vaginal fornix?
The rectouterine pouch (pouch of Douglas) is accessible to palpation through the posterior vaginal fornix. This allows for diagnostic aspiration when blood or pus accumulation is suspected, as well as performing a colpotomy.
How is the transverse vesical fold formed?
The transverse vesical fold is formed near the pubic symphysis as the peritoneum reflects onto the urinary bladder. As the organ fills, this fold smooths out, and the peritoneum shifts upward.
What else to study on this topic
- Anatomy and fixation of the uterine ligamentous apparatus (broad, round, and uterosacral ligaments)
- The subperitoneal pelvic tier (cavum pelvis subperitoneale) and its fascial spaces
- Extraperitoneal surgical interventions and urinary bladder puncture
- Structure and functions of the Denonvilliers-Salishchev fascia
- Topography of the ampullae of the vas deferens and seminal vesicles
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