ʻO Douglas ka inoa o ke kauka anatomist Scottish ʻo James Douglas (1675-1742), nāna i hāʻawi i kona inoa i nā ʻano cul-de-sac like ʻole o Douglas a me nā pathologies i hoʻopili ʻia iā ia: douglassectomy, douglascele, douglassite, laina Douglas, a pēlā aku. .

Ua wehewehe ʻia ka Douglas 'cul-de-sac e nā anatomists ma ke ʻano he pelu o ka peritoneum aia ma waena o ka poli a me ka uterus, e hana ana i ka cul-de-sac.

Aia ʻo Douglas 'cul-de-sac ma kahi mamao ma lalo o ka umbilicus o 4 a 6 cm. ʻO ia ka lae haʻahaʻa o ka lua o ka peritoneal, ka mea i hana ʻia e ka peritoneum, kahi membrane serous e hoʻopili ana i ka lua o ka ʻōpū.

I nā kāne

I nā kāne, aia kēia cul-de-sac ma waena o ka hakahaka a me ka pololei. ʻO ia wale ka hopena haʻahaʻa o ka lua o ka peritoneal, ma waena o ka ʻaoʻao hope o ka ʻōpū a me ka ʻaoʻao mua o ka kiko.

I nā wahine

No nā wahine, ua kapa ʻia ka ʻeke Douglas ka ʻeke recto-uterine, aia ia ma waena o ka palahu a me ka uterus. No laila kaupalena ʻia ia ma hope e ke kiko, i mua o ka kōpū a me ka ʻōpū; a ma hope e nā recto-uterine mau pelu.

ʻO kāna kuleana ke kākoʻo i nā ʻōpala a pale iā lākou i nā maʻi.

hana

Hana ʻia ia i nā pūnaewele hoʻopili paʻa i loko o nā protein like collagen-like, a me nā fiber elastis. Kapa ʻia kēia membrane paʻa i ka aponeurosis. 

Hiki i kēia membrane ke hūnā i nā serosities, kahi ʻano o ka wai lymphatic e like me ka ʻāpana wai o ke koko i kapa ʻia he plasma. 

Hoʻokumu ke serum i nā membrane serous ʻo ia nā membrane e kau ana i nā lua i paʻa o ke kino.

Loaʻa ʻia ʻo Douglas 'cul-de-sac e kahi hoʻokolohua wahine i nā wahine, e kahi hoʻokolokolo kūpono i nā kāne.

ʻAʻole ʻehaʻeha kēia ninaninau palpation kikoʻī.

Inā pili kēia ʻeha i ka ʻeha, uē ka mea hoʻomanawanui no ka mea ʻeha loa ka ʻeha. ʻIke ʻia kēia uē e nā ʻoihana olakino "ʻo ka uē o nā Douglas" ʻoiai he kikoʻī loa nā ʻōuli.

Hōʻike ʻo Palpation i kahi effaper intraperitoneal, abscess a i ʻole tumo paʻa. I ka hanana o abscess, hiki i ka palpation ke ʻeha loa.

Hiki i kēia ʻeha ke hōʻailona o ka lehulehu o nā pathologies i hiki ke pae ʻia mai kahi hāpai hāpai ectopic i nā wahine, kahi hernia a i ʻole douglassitis.

Ectopic (a i ʻole ectopic) hāpai keiki 

Hoʻokumu kahi hāpai ectopic (a i ʻole ectopic) ma waho o ka lua uterine:

• i ka paipu fallopian, he hāpai omo ia;
• i ka ovary, he hāpai ovarian ia;
• i ka lua o ka peritoneal, he hāpai ʻōpū ia.

I ka hihia o kahi hāpai ectopic, ʻo ka nānā ʻana o ka wahine i ka wahine hānau a ʻeha paha he mea ʻeha loa (Douglas pain) a hiki pū me ka syncope, pallor, ka wikiwiki wikiwiki, ke kuni, ka ʻōhū. Hiki ke hoʻopiha i ka Douglas i ke koko kala ʻeleʻele sepia.

ʻO ka effusion o ka pelvis liʻiliʻi, no laila ma hope o kēia vaginal cul-de-sac, ma hope o ka kōpū, ʻike pinepine ʻia i ka hanana o ka hāpai ectopic ruptured. Kuhi kēia haki i kahi effusion koko e hōʻiliʻili ma hope o kēia cul-de-sac. ʻO kona palpation a laila ʻeha loa a koʻikoʻi loa no ka hōʻailona.

Hoʻokumu ʻia kēia iho ʻōiwi (a i ʻole prolaps) e kahi hernia o ka ʻōpū i iho i loko o ka Doug-cul-de-sac a hoʻokuli i ka paia o hope i loko o ka vulva.

ʻO Douglassitis kahi mumū mau o ka peritoneum e waiho nei i loko o ka ʻeke Douglas-fir. Hoʻokumu pinepine ʻia ia e kahi intraperitoneal effusion (i ka peritoneum, kahi tumo, kahi hōʻiliʻili o ke koko mai ka hemorrhage i hoʻokumu ʻia e GEU (ectopic hāpai keiki) a i ʻole kahi abscess a abscess paha.

Hana ke kauka i kahi rectal (no ke kāne) a i ʻole vaginal (no ka wahine) e ʻike i ke kūlana o ka cul-de-sac.

Nā hana ʻokoʻa

Ke pono e hemo i ka effusion, hana ke kauka i ke kahawai. No nā wahine, he colpotomy ia, kahi hoʻopili ma o ka paia āpau a no nā kāne ua kapa ʻia kēia mea he rectotomy, no ka mea ua hana ʻia ka mea i loko o ka paia o ka pā.

Ke hoʻopiha ʻia ʻo Douglas 'cul-de-sac me ke koko a i ʻole ka wai, no laila he mea pono e hana i ke kahawai, keu hoʻi i nā wahine ma o nā paia āpau. ʻO kēia kuhi ka colpotomy.

I ke kanaka, pono ka hoʻokahe ʻana i kekahi manawa i kekahi manawa. I kēia hihia he mea pono e hoʻokō iā ia ma o ka paia mua o ka pololei, ua kapa ʻia kēia hoʻopili ʻana he rectotomy.

ʻO ka localization o kahi effusion hiki ke hōʻoia e kahi ultrasound a me kahi puncture kikoʻī kona ʻano.

Douglassectomy

ʻO Douglassectomy kahi hana ʻoki e pili ana i ka lawe ʻana iā Douglas 'cul-de-sac. Hana ʻia ia e laparoscopy a i ʻole ma o ka wehe ʻana i loko o ka ʻōpū i kapa ʻia he laparotomy.