From the Guidelines
The ovaries sitting in the pouch of Douglas is not typically a cause for concern, as it is considered a normal anatomical variation. This variation can occur in some women due to the natural mobility of the ovaries within the pelvis, which can be influenced by factors such as bladder fullness, bowel distension, or body position 1. The location of the ovaries in the pouch of Douglas is generally not a cause for concern unless it is associated with symptoms such as pelvic pain, painful intercourse, or other symptoms that may be related to conditions like endometriosis or pelvic adhesions.
Some key points to consider include:
- The ovaries are naturally mobile structures within the pelvis and can shift positions based on various factors.
- The presence of ovaries in the pouch of Douglas without symptoms does not require treatment or intervention.
- During gynecological examinations or pelvic imaging, healthcare providers may note this positioning, but it is generally considered an incidental finding rather than a pathological condition.
- The body's pelvic anatomy has natural variations, and this particular variation does not impact ovarian function or fertility.
In the context of endometriosis, the uterine sliding sign has been shown to have good diagnostic performance for detection of endometriosis involving the bowel and pouch of Douglas 1. However, the mere presence of ovaries in the pouch of Douglas without symptoms does not necessarily indicate endometriosis or any other pathological condition.
It is essential to note that while the ovaries sitting in the pouch of Douglas is generally not a cause for concern, any symptoms or concerns should be discussed with a healthcare provider to determine the best course of action.
From the Research
Ovarian Torsion and Pouch of Douglas
- Ovarian torsion is a rare but emergency condition in women, and early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity 2.
- The main risk in ovarian torsion is an ovarian mass, and the most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting 2.
- There is a case report of an ovarian cyst impacted in the pouch of Douglas at 20 weeks' gestation, which was managed by laparoscopic ovarian cystectomy 3.
- The pouch of Douglas is a potential space where the ovaries can become trapped, and ovarian torsion can occur in this location 3.
Diagnosis and Treatment
- Pelvic ultrasonography can provide information on ovarian cysts, and once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment 2.
- Computed tomography findings, plasma d-dimer level, and the time from pain onset play a critical role in distinguishing ovarian necrosis 4.
- Surgical management should be focused on fertility preservation, and this is achievable through ovarian detorsion ± ovarian cystectomy ± oophoropexy to avoid recurrence 5.
- More urgent intervention for ovarian torsion, with liberal use of diagnostic laparoscopy and without reliance on a definitive diagnosis by imaging, should be considered in girls with lower abdominal pain 6.
Clinical Presentation and Risk Factors
- Abdominal pain, nausea, and vomiting were normal clinical presentations of ovarian torsion 4.
- The frequency of ovarian cysts in pregnancy is reported to be 1 in 1000 pregnancies, and laparoscopic ovarian cystectomy has been described in the literature as a safe and beneficial procedure for pregnant women 3.
- Underlying lesions can be found in half of cases of ovarian torsion in the pediatric population, with benign neoplasms (teratomas or cystic lesions) representing the commonest etiology 5.