An extrarectal mass in the recto-uterine or rectovesical space is encountered frequently in the course of routine digital examination of the rectum. The significance of the mass seldom is recognized, and it is sometimes confused with primary carcinoma of the rectum. Because of the prognostic and diagnostic importance of extrarectal tumors, digital and proctoscopic examination should not be omitted in cases of obscure abdominal disease.
In 1895, Strauss,1 discussing some cases of operative carcinoma of the stomach, stated: "Carcinomatous metastases in the liver were found at operation in this case, also in the retroperitoneal tissue, and in Douglas' pouch. The latter situation we have found repeatedly as a site of metastases in carcinoma of the stomach and which on account of its accessibility to digital exploration merits more frequent attention during examination." This is the first mention that we have found in the literature of malignant growths in the pelvis secondary to primary gastric carcinoma; the importance of these growths was overlooked for fourteen years, until Blumer's 2 description in 1909. Since then "Blumer's shelf" has been mentioned frequently (figs. 1, 2 and 3). According to Blumer's original article, the