-
Douglas space free fluid
Hello!
I apologize if this is not the correct forum.
[link=https://www.grepmed.com/images/6270/freefluid-clinical-pelvis-pelvic-pocus]https://www.grepmed.com/i…al-pelvis-pelvic-pocus[/link]
My question is, the free fluid on the above ultrasound is clearly the large anterior one with hyperechoic material (clots i suppose), however, everywhere I read it says that the fluid should be in the Douglas space, posterior to the bladder.
Can somebody please explain to me… does the above rule go out of the window once there is too much free fluid? Is there another way to easily assess and distinguish between the bladder and the free fluid? (besides bladder anterior, free fluid posterior)
Thanks a lot! -
1 Reply
-
Would like to know more about this case ie is this a male or female patient? If female post hysterectomy or no?
In either case the main question is whether the fluid is jntraperitoneal or extraperitoneal. Based on the US it looks intraperitoneal. The term free fluid is typically used for intraperitoneal fluid, meaning the fluid can travel anywhere in the peritoneum, although typically collects in gravity dependent spaces like the posterior cul de sac. As you mentioned when there is enough fluid, it may be both behind and in front of the uterus, superior to the bladder, and extend higher up into the abdominal cavity.
The pouch of Douglas is specifically regarding the space of the peritoneum between the uterus and rectum, where debris and/or tumor can tend to collect because of gravity
