UDouglas yigama likadokotela waseScotland owaziwa ngokuthi yi-anatomist doctor James Douglas (1675-1742), owanikeza igama lakhe emigomweni ehlukahlukene ye-cul-de-sac kaDouglas kanye nezifo ezixhumene nayo: douglassectomy, douglascele, douglassite, ulayini weDouglas, njll. .

I-cul-de-sac yeDouglas ichazwa ngama-anatomists njengefolda ye-peritoneum etholakala phakathi kwe-rectum nesibeletho, yakha i-cul-de-sac.

I-cul-de-sac kaDouglas itholakala ebangeni elingaphansi kwenkaba ka-4 kuye ku-6 cm. Liyindawo ephansi kakhulu yomgodi we-peritoneal, uqobo lwayo olwakhiwa yi-peritoneum, ulwelwesi oluyisigaxa olugqize umgodi wesisu.

Kwabesilisa

Emadodeni, le cul-de-sac itholakala phakathi kwesinye kanye nengxenyeni. Kumane kungukugcina okuphansi kwesikhala se-peritoneal, phakathi kwendawo engemuva yesinye nobuso bangaphandle be-rectum.

Kwabesifazane

Kwabesifazane, isikhwama sikaDouglas sibizwa nangokuthi isikhwama se-recto-uterine, sitholakala phakathi kwe-rectum nesibeletho. Ngakho-ke kunqunyelwe ngemuva yi-rectum, ngaphambili ngesibeletho kanye nesitho sangasese sowesifazane; futhi kamuva ngamaphakethe we-recto-uterine.

Umsebenzi wayo ukuxhasa izitho nokuzivikela ezifweni.

Operation

Yenziwe ngezicubu ezihlanganisiwe eziqukethe amaprotheni afana ne-collagen, kanye nemicu e-elastic. Lolu ulwelwesi oluqinile lubizwa nangokuthi i-aponeurosis. 

Lolu ulwelwesi lunamandla okukhipha ama-serosities, uhlobo oluthile luketshezi lwe-lymphatic elilingana nengxenye engamanzi yegazi ebizwa nge-plasma. 

Amafomu weSerum ezingxenyeni ze-serous okuyizinhlamvu ezihambisana nezikhala zomzimba ezivalekile.

I-cul-de-sac kaDouglas iyatholakala ngokuhlolwa kwesitho sangasese sowesifazane, ngokuhlolwa kwamakhondomu emadodeni.

Lokhu kuhlolwa kwe-digital palpation ngokuvamile akunabuhlungu.

Uma lokhu kuthinta kubangela ubuhlungu, isiguli siyakhala ngoba ubuhlungu bunodlame kakhulu. Lesi sililo saziwa ngochwepheshe bezempilo ukuthi "yisililo sikaDouglas" njengoba izimpawu zicace bha.

I-Palpation ikhombisa ukukhishwa kwe-intraperitoneal, ithumba noma isimila esiqinile. Uma kwenzeka ithumba, ukushaya kwenhliziyo kungaba buhlungu kakhulu.

Lobu buhlungu bungaba yisibonakaliso senqwaba yezifo ezingasukela ekukhulelweni kwe-ectopic kwabesifazane, i-hernia noma i-douglassitis.

Ukukhulelwa kwe-Ectopic (noma i-ectopic) 

Ukukhulelwa kwe-ectopic (noma ectopic) kukhula ngaphandle komgogodla wesibeletho:

• kushubhu le-fallopian, ukukhulelwa kwe-tubal;
• ku-ovary, kungukukhulelwa kwe-ovarian;
• emgodini we-peritoneal, ukukhulelwa kwesisu.

Endabeni yokukhulelwa kwe-ectopic, ukuhlolwa kwesitho sangasese sowesifazane obelethisayo noma umbelethisi kubuhlungu ngokweqile (ubuhlungu bukaDouglas) futhi kungahle kuhambisane ne-syncope, i-pallor, i-pulse ye-acceleration, umkhuhlane, ukuqumba. IDouglas ingagcwaliswa ngegazi elinombala onsundu we-sepia.

Ukwehliswa kwesikhumba esincane, ngakho-ke ngemuva kwalesi sangasese se-cul-de-sac, ngemuva kwesibeletho, kuvame ukuhlangana nakho uma kwenzeka ukukhulelwa kwe-ectopic kuqhume. Lokhu kuqhekeka kubangela ukuchithwa kwegazi okunqwabelana ngemuva kwale cul-de-sac. Ukushaya ngamandla kwayo kubuhlungu ngokweqile futhi kubaluleke kakhulu ekuxilongweni.

Lokhu kwehla kwesitho (noma ukuphindaphindeka) kubangelwa i-hernia yamathumbu eyehlele ku-Douglas 'cul-de-sac futhi ehlohla udonga lwangasese lwangasese emuva ngemvubu.

I-Douglassitis ukuvuvukala okungapheli kwe-peritoneum etholakala esikhwameni seDouglas-fir. Imvamisa kubangelwa i-intraperitoneal effusion (ku-peritoneum, isimila, iqoqo legazi elivela ekopheni okubangelwa yi-GEU (ectopic pregnancy) noma ithumba noma ithumba.

Udokotela wenza i-rectal (yendoda) noma isitho sangasese sowesifazane (kowesifazane) ukwazi isimo se-cul-de-sac.

Ukungenelela okuhlukile

Lapho i-effusion idinga ukususwa, udokotela wenza amanzi. Kwabesifazane, yi-colpotomy, ukungenelela odongeni lwesitho sangasese sowesifazane nakwabesilisa lokhu kungenelela kubizwa ngokuthi yi-rectotomy, ngoba ukungenelela kwenziwa ngodonga olungunxande.

Lapho i-cul-de-sac kaDouglas igcwele igazi noma uketshezi, ngakho-ke kuyadingeka ukwenza amanzi, ikakhulukazi kwabesifazane ngezindonga zangasese. Lesi senzo yi-colpotomy.

Kubantu, ukudonsa amanzi kwesinye isikhathi kuyadingeka futhi. Kulokhu kuyadingeka ukuyenza ngodonga lwangaphakathi lwe-rectum, lokhu kungenelela kubizwa ngokuthi yi-rectotomy.

Ukwenziwa kwasendaweni kwe-effusion kungaqinisekiswa yi-ultrasound kanye nokubhoboza okuqondile ubunjalo bayo.

I-Douglassectomy

I-Douglassectomy inqubo yokuhlinza efaka ukususa i-cul-de-sac kaDouglas. Kwenziwa nge-laparoscopy noma ngokuvula esiswini okubizwa ngokuthi yi-laparotomy.