480 ABDOMEN 



and the round ligament of the uterus, the two layers of the 

 broad ligament include between them other structures, viz., (i) 

 the epoophoron-j (2) the uterine and ovarian blood-vessels and 

 nerves and lymph vessels. 



Peritoneal Fossae. The paravesical fossae lie in front of 

 the broad ligament, at the sides of the urinary bladder. 



Each middle or genital fossa is bounded anteriorly by the 

 back of the broad ligament and a ridge, called the ureteral 

 ridge because it is caused by the projection of the ureter, and 

 posteriorly by a fold of peritoneum, called the utero-sacral 

 fold, which is similar to the sacro-genital fold of the male 

 (p. 412). Each utero-sacral fold is semilunar in form, and 

 curves from the back of the uterus to the posterior wall of 

 the pelvis, at the side of the rectum. Between its two layers 

 there are some unstriped muscular fibres as well as connective 

 tissue. The two folds meet across the back of the uterus, 

 where they form a projection known as the torus uterinus. 



The pararectal fossae are situated at the sides of the empty 

 rectum, between it and the utero-sacral fold. 



Excavatio Recto-uterina (O.T. Pouch of Douglas). The 

 recto-uterine pouch corresponds to the recto-genital pouch or 

 recto-vesical excavation in the male. Anteriorly, it is bounded 

 by the peritoneum covering the upper part of the posterior 

 wall of the vagina and the lower part of the back of the 

 uterus ; posteriorly, by the peritoneum on the rectum ; while 

 on each side is the utero-sacral fold of peritoneum. It is 

 continuous with the pararectal fossae, which are obliterated 

 when the rectum is distended (p. 413). 



Excavatio Vesico-uterina. The vesico-uterine pouch is a 

 shallow depression, not always distinguishable, between the 

 uterus and the upper part of the base of the urinary 

 bladder. It is bounded laterally by two slight folds of peri- 

 toneum termed the utero-vesical folds. 



Dissection. The dissector should cut through the lateral 

 false ligaments of the urinary bladder at their junctions with 

 the lower borders of the anterior surfaces of the broad ligaments : 

 he should then reflect the lateral false ligaments medially to 

 the lateral borders of the upper surface of the urinary bladder. 

 Next, he should draw the apex of the bladder backwards and 

 pass his index ringer down through the soft fat, between the 

 anterior border of the bladder and the back of the symphysis 

 pubis, till he feels the resistance of the upper fascia of the pelvic 

 diaphragm, which passes medially from the wall of the pelvis 

 to the bladder, and which is thickened on each side of the median 



