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Cyst hydatid disease is a parasitic zoonosis caused by the larvae of the tapeworm belonging to the Echinococcus species. While hydatid disease can affect almost any part of the human body, the liver and lung are the two organs where the disease is most frequently detected. Peritoneal involvement may develop following a hepatic hydatid cyst surgery or as a result of spontaneous micro-ruptures of the hepatic hydatid cyst into the peritoneal cavity. However, with only a few reported cases, primary hydatid cyst in the rectovesical pouch is extremely rare, even in endemic regions. In this study, a 37-year-old man admitted to the emergency department with frequency and nocturia diagnosed as having a primary hydatid cyst in the rectovesical pouch., Kist hidatik hastalığı, Echinococcus türüne ait tenya larvalarının neden olduğu parazitik bir zoonozdur. Kist hidatik insan vücudunun hemen her yerini etkileyebilirken, karaciğer ve akciğer hastalığın en sık görüldüğü iki organdır. Hepatik kist hidatik cerrahisini takiben veya hepatik hidatik kistin periton boşluğuna spontan mikro rüptürleri sonucu periton tutulumu gelişebilir. Bununla birlikte, bildirilen sadece birkaç vaka ile,endemik bölgelerde bile rektovezikal poşta primer kist hidatik oldukça nadirdir. Bu çalışmada acil servise sık idrara çıkma ve noktüri şikayeti ile başvuran ve rektovezikal poşta primer kist hidatik tanısı alan 37 yaşında erkek bir hasta sunulmaktadır.

This case study discusses a patient presenting with urinary retention presumed secondary to benign prostatic hyperplasia (BPH). Suspicion for an underlying problem was raised when a second instance of urinary retention occurred after undergoing medical treatment and TUVP to correct BPH. Extensive workup resulted in diagnosis of small cell lung carcinoma with metastases and discovery of a large metastatic mass in the rectovesical pouch. The mass caused obstructive uropathy and renal failure which was managed with stenting and an indwelling catheter. Further investigation by practitioners may be required in patients whose urinary symptoms do not improve after standard BPH treatments.

Dislocation of the epicardial pacemaker into the peritoneal cavity is an uncommon but potentially life-threatening complication. We report a case of a 74 year old with an abdominally implanted epicardial pacemaker that migrated through the peritoneum to the excavatio rectovesicalis. The laparoscopic approach was chosen because of the increased risks of perioperative morbidity and decreased survival. The generator was implanted into a pocket beneath the anterior rectus sheath and the lead was peritonalized with a running suture. In conclusion, a laparoscopic retrieval is feasible and safe in the treatment of a displaced pacemaker in the rectovesical pouch.

Robot-assisted laparoscopic radical prostatectomy (RARP) is currently the standard surgical treatment for localized prostate cancer. Since 2010, Dr. Aldo Bocciardi has developed a new anatomical approach through the rectovesical pouch at Niguarda Hospital in Milan.

Symptomatic benign conditions of seminal vesicle (lesions like cysts which need intervention) can be managed laparoscopically because the vision is better and the access is easier than in open surgery [1, 2].

Symptomatic Mullerian duct cyst is a rare entity in children. A 9-month-old male infant presented with bowel and urinary obstructive symptoms. Imaging investigations revealed a cystic mass in the rectovesical pouch compressing bladder neck and rectum. At laparotomy, a Mullerian duct cyst was found. Most of the cyst was excised and the remaining cyst mucosa was cauterized. The child improved thereafter.

結腸癌術後腹膜再発は播種性再発が多く，予後不良であるが，まれに孤立性に腹膜転移を認める．S状結腸癌術後の直腸膀胱窩孤立性再発に対して再切除を施行し長期生存を得た症例を経験したので，本邦報告5例の文献的考察とともに報告する．症例は54歳男性でS状結腸進行癌に対しS状結腸切除術D3郭清を施行．病理組織学的診断はType 2，pSS，pN0，P0，H0，R0，高分化型腺癌，Stage II であった．術後16ヵ月目よりCEAの上昇を認め，Fluorodeoxyglucose-positoron emission tomography（以下FDG-PET）CT検査で直腸膀胱窩の直腸右側壁に径15mmの腫瘍を認めた．吻合部および他臓器への転移再発なく，孤立性腹膜転移再発，根治切除が可能と判断し，初回術後24ヵ月目に低位前方切除術を行った．病理組織型は初回手術同様の高分化型腺癌であった．再切除後5年2ヵ月無再発経過観察中である．

術後直腸膀胱窩膿瘍に対し, 経皮経膀胱膿瘍穿刺吸引が奏功した1例を報告する. 症例は84歳の男性で, 腹痛, 嘔吐を主訴に来院した. 小腸腫瘍による不全イレウスと診断し小腸部分切除術を施行した. 術後第17病日, 下腹部不快感と血液検査上炎症所見の増悪を認めたため腹部造影CT を施行し, 術後腹腔内膿瘍が疑われた. 経皮経膀胱的に膿瘍を穿刺し十分洗浄後穿刺針は抜去した. 処置翌日より臨床症状の改善を認め, 術後第30病日, 処置後第14病日退院となった. 術後直腸膀胱窩膿瘍は具体的報告例が少なく, 文献的考察を加え報告する.

Primary squamous cell carcinoma (SCC) is extremely rare in the seminal vesicle. A 26-year-old male patient presented with complaints of difficulty in urination for 10 years and gross hematuria for 7 months. Ultrasonography and computed tomography imaging demonstrated a large mixed solid/cystic mass lesions in the rectovesical pouch. The mass was completely resected with the open approach and was verified as a primary SCC of the seminal vesicle by post-surgical histopathological examination. Pelvic metastases were detected 28 months after the surgery. This is the third reported case of primary SCC of the seminal vesicle, and the first one in a young patient. Early diagnosis and treatment are crucial for primary SCC of the seminal vesicle.

S状結腸癌術後の直腸膀胱窩再発に対し切除を行い, 長期無再発生存したまれな1例を経験したので報告する. 症例は57歳の男性. 1995年 (55歳) S状結腸癌に対しS状結腸切除+D3郭清を施行. 病理組織診断は中分化腺癌, ss, n0, ly1, v1であった. 1996年4月からCEAの上昇を認め, 12月に直腸膀胱窩に腫瘤を触知した. CTにて精嚢背側に1cm大の孤立性の腫瘤を確認し結腸癌の腹膜再発と診断した. 1997年3月手術を施行. 翻転部から精嚢背側にかけての腹膜下を主座とする3cm大の腫瘍で, 翻転部の腹膜にひきつれをともなっていた. 低位前方切除と両側精嚢切除により根治的手術を行いえた. 組織診断は中分化腺癌であった. 2002年3月, 再切除後5年を経過したが, 再発徴候を認めていない.

We present a large hydatid cyst located midline and posterior to prostatic gland and seminal vesicles in an asymptomatic patient. Computed tomography (CT) scan revealed a large retrovesical mass and the transrectal ultrasonography idetified a degenerated hydatid cyst with “ball of wool’’ appearance. Although extremely rare, hydatid disease should be kept in mind in the differential diagnosis of pelvic particularly retrovesical midline masses.

A 5-year-old boy born with a congenital heart defect had insertion of an epicardial pacemaker that was found on routine evaluation to have been displaced into the rectovesical pouch. He underwent transvenous insertion of another pacemaker, and the displaced pacemaker was successfully retrieved by laparoscopy without incident.

Key Clinical Message A 66-year-old man with rectal cancer was found to have an incidental ring-like lesion in the left rectovesical pouch. Histology revealed an encapsulated fat necrosis. Intraperitoneal encapsulated fat necroses are postulated to be a result of infarcted epiploic appendages resulting in a free-floating lesion.

Background: Fluoroscopically guided guidewire manipulations are readily available and inexpensive methods of correcting malfunctioning peritoneal dialysis catheters, with reported success rates ranging from 25% to 67%. Purpose: To improve the success rates of guidewire manipulations with a modified technique. Material and Methods: Using a stiff rod and a stiff wire under fluoroscopy guidance, catheters that had migrated were drawn back into the rectovesical pouch. An angular rod was used to lever the catheter downward, and the guidewire was used to push the catheter down. Results: No complications developed, and immediate success was achieved in 13 of 14 interventions. With this technique, catheter patency in chronic ambulatory peritoneal dialysis (CAPD) patients (11/12) was higher than that of previously reported methods. Durable success was maintained in nine of 12 patients after a single intervention. All re-manipulations (2/2) were successful. Conclusion: Although used in only 14 interventions in 12 patients, the outcome was promising. This method is a safe and favorable alternative to other guidewire manipulations, based on absence of complications and high success.

Paediatric splenic abscesses are rare, but can be fatal. An 8-year-old boy developed recurrent fever and abdominal pain 5 months after undergoing an appendectomy. A CT scan showed splenic and rectovesical pouch abscesses. The patient was successfully treated with antibiotics, and laparoscopic drainage and debridement of pus from the rectovesical pouch abscess. Eggerthella lenta was cultured from the latter lesion. Early diagnosis and treatment resulted in the satisfactory resolution of the infection.

Summary— The endoscopic subtrigonal injection of a 6% aqueous phenol solution is an effective technique for denervating the bladder but its clinical usefulness is limited by unpredictable side effects. This study explored the possibility of making this procedure safer by comparing the neurolytic effects of different concentrations and carriers of phenol. Phenol in 2.5 and 5% solutions in three different carriers (water, glycerine and oil) was injected into the rectovesical pouch in 35 rats. After 3 weeks the bladders were excised and the effects on the density of acetylcholinesterase-positive nerves were assessed in each animal using morphometric techniques. The density of enzyme-containing nerves was reduced by 20% in the phenolised animals when compared with controls. This reduction was maximum when water was used as the carrier for either 2.5 or 5% phenol solutions.

It would seem that the chairman's address should deal with a subject which is of interest to gastro-enterologists and proctologists alike, and for this reason I have chosen to call or recall attention to the question of the diagnosis and prognosis of epithelial tumors of the large bowel. Tumors actually arising from the bowel epithelium must be differentiated masses projecting into the bowel lumen and are merely covered with bowel mucosa. In cases in which the bowel mucosa covering a mass is normal there is no question, but when the mucosa is ulcerated or when a tumor has broken through the mucosa and is projecting into the bowel lumen, as is sometimes the case with prostatic carcinoma or metastatic nodes in the rectovesical pouch, or culdesac of Douglas, some confusion may arise. Certain tumors arising in the bowel wall, such as lipomas or myxomas, may give this picture, as may