00:01
Now, let's turn our attention
to the organs
that reside within the pelvis
by looking at a sectioned pelvis.
00:08
And we'll look at the difference
between male and female
before we then go on to look
at these in more detail later on.
00:15
So, let's start by
looking at a sectioned male pelvis.
00:18
So, what we're doing
is we're looking
into the right pelvic cavity.
00:23
So, all of these organs
are really cut in half
and we're looking at the
cut surface of their right side.
00:30
So, to the left of the screen,
we have the anterior aspect,
And then to the right of the screen,
we have the posterior aspect.
00:37
And the pelvis has been sectioned
down in the mid-sagittal plane
So directly down
the midline of the body.
00:45
Here we can see most anteriorly.
We have the pubic symphysis.
00:48
And then directly posterior
to the pubic symphysis,
we have the bladder.
00:53
Inferior to the bladder,
we have the prostate,
And then posteriorly
again, within the male,
we find we have the rectum.
01:00
Most posteriorly, again, you'd then
find the sacrum and the coccyx.
01:04
Superiorly,
lying over all of these organs,
we find a layer of peritoneum.
01:10
And this peritoneum is continuous
with that of the abdomen.
01:13
It is one continuous sheet.
01:16
And as you remember,
the peritoneum will run down
in the anterior abdominal wall.
01:20
And then it becomes reflected
off the anterior abdominal wall
as it runs over the
superior surface of the bladder.
01:26
And it will then run up and
associate itself with the rectum
as it then covers the
remainder of the abdomen.
01:34
So, a lot of these organs
that we're talking about here
are really kind of sub peritoneal.
01:39
They're very much
underneath the peritoneum.
01:42
They do not have mesentery
or they will come back to the rectum
in a moment or two.
01:47
They do not have a mesentery
that suspends them
like the abdominal organs,
and they're situated underneath
or deep to the peritoneum.
01:55
Here we can see because
of the folds of the peritoneum,
as they run through the contours of
those structures within the pelvis,
we can see as it runs
over the bladder,
and then it goes
towards the rectum.
02:06
It actually follows the
contours of the bladder,
which goes
posteriorly and inferiorly.
02:12
Before then running up alongside
the anterior surface of the rectum.
02:18
This creates a very important pouch
that's positioned between
the posterior aspect of the bladder
and the anterior
aspect of the rectum.
02:26
And this is known as
the rectovesical pouch.
02:29
Within the female
reproductive organs,
and we'll see that within this space
we have the uterus.
02:34
And that actually splits
that space into two pouches.
02:37
We'll come back to that
in a moment or two.
02:39
But here within the male
we have the rectovesical pouch
formed by the layer of peritoneum
covering these pelvic organs
forming that space between
the bladder anterior
and the rectum, posteriorly.
02:52
Now, if we introduce the
female organs into this image.
02:56
Again, anteriorly, we can see
the pubic symphysis here,
and then most posteriorly
will see the sacrum
to the right hand side
of the screen.
03:03
Again, immediately posterior to the
pubic symphysis we find the bladder.
03:08
But this time,
as we continue moving posteriorly,
we do not immediately find
the rectum. We find the uterus.
03:15
So, here between the bladder and
the rectum, we find the uterus.
03:20
Running now inferiorly,
along the posterior aspect
of the bladder,
do we find the vagina.
03:26
If we then move posterior
to the uterus and the vagina,
we find the rectum.
03:31
And then most posteriorly
as I've mentioned,
we'll have the sacrum.
03:36
So now if we introduce our layer
of peritoneum onto this image,
we can see exactly
the same thing as occurring here.
03:43
Peritoneum is running
down the anterior aspect
of the anterior abdominal wall.
03:48
It then runs all the way down
and reflects over
the surface of the bladder.
03:53
But this time, it will then run up
over the uterus.
03:57
So we can follow that
green line as it comes down
from the posterior surface
of the anterior abdominal wall.
04:02
It runs down onto
the surface of the bladder.
04:05
It then folds back on itself
as it goes over the
body of the uterus.
04:10
It then curves over the uterus
onto its posterior surface
before then running up the
anterior surface of the rectum.
04:20
Now, if you imagine
from the male pelvis,
we didn't have the uterus,
we had that layer of peritoneum.
04:26
Now the uterus has protruded
through that space,
and we can see it's
created two pouches.
04:32
So, now between
the bladder anteriorly
and the uterus posteriorly,
we have the vesicouterine pouch.
04:39
Positioned between
the uterus anteriorly
and the rectum posteriorly,
we have the rectouterine pouch.
04:47
Some textbooks some older textbooks
may call this a pouch of Douglas,
but very much use the kind
of the rectouterine pouch
as a way to differentiate that
from the vesicouterine pouch.
04:59
The rectouterine pouch is a really
important pouch in the female
as the lowest part
of the peritoneal cavity.
05:06
And therefore because
it's the lowest part,
accumulation of free fluid, or pus
can be found within this space.
05:13
If there's an infection,
for example.
05:16
The way for that pus or
free fluid to be removed
is through a transvaginal approach.
05:22
So penetrating the posterior fornix,
we'll see the posterior fornix
in a later slide,
by passing through
the vaginal vault
will enable this fluid
to be drained from this space.