Culdocentesis
Culdocentesis is a medical procedure performed to assess the presence and nature of fluid in the pelvic or abdominal cavity in women, particularly when the cause is uncertain. It is indicated in cases of acute abdominal pain and can help identify fluid associated with conditions such as active bleeding, infections, or organ perforations. During the procedure, the patient is positioned on her back, and a speculum is used to lift the cervix for access via a thin needle inserted through the vaginal wall into the cul-de-sac of Douglas, allowing for fluid aspiration and subsequent analysis.
While culdocentesis has largely been supplanted by noninvasive imaging techniques, such as pelvic ultrasound, it can still provide valuable diagnostic information. For instance, the characteristics of the aspirated fluid can inform whether urgent surgical intervention is needed for conditions like ruptured ectopic pregnancies or gastrointestinal perforations. The procedure carries minimal risks, with complications such as internal organ perforation, bleeding, or infection being very rare. Understanding culdocentesis can be crucial for patients experiencing unexplained abdominal symptoms, highlighting both its diagnostic utility and the importance of careful clinical evaluation.
Subject Terms
Culdocentesis
Anatomy or system affected: Abdomen, reproductive system
Definition: A diagnostic procedure in which fluid in the cul-de-sac of Douglas, the space behind the uterus and front of the rectum, is removed using a needle inserted through the vagina
Indications and Procedures
Culdocentesis is indicated in cases where a woman is suspected of having fluid in the abdomen or pelvis with an unclear cause. The patient may have an acutely painful and tender abdomen. Culdocentesis can identify the presence of fluid in the pelvis as well as distinguish whether the fluid is the result of active bleeding, infection, a perforated organ, or other causes.
For culdocentesis, the patient lies on her back with her legs in stirrups as for a pelvic examination. A speculum is inserted into the vagina to visualize the cervix, and the cervix is gently lifted with a grasping instrument. A long, thin needle is inserted through the vagina, behind the cervix, and into the cul-de-sac of Douglas. Any fluid in this cul-de-sac is aspirated, and analysis of the fluid is subsequently performed.
Uses and Complications
Culdocentesis is not common, as noninvasive imaging modalities such as pelvic ultrasound with vaginal transducer have replaced this procedure to evaluate fluid collections in the abdomen and pelvis. Nevertheless, culdocentesis can yield useful information regarding the nature of abdominal or pelvic fluid, and hence it can assist in diagnosis and treatment decisions. For instance, nonclotted bloody fluid can be consistent with active bleeding, such as from a ruptured ectopic pregnancy or hemorrhagic ovarian cyst. Either of these conditions may require immediate surgery to stop the bleeding. The fluid aspirated from the cul-de-sac may be bile or bowel contents, indicating perforation of the gastrointestinal tract and possible need for urgent surgery. Infected fluid suggests pelvic inflammatory disease (PID) or abscess, for which surgery may not be the first line of treatment. Nonbloody, noninfected fluid may be caused by the rupture of a benign ovarian cyst, which would not require intervention.
Complications associated with culdocentesis are very rare. They include the perforation of internal organs, such as the bowel or uterus, with the needle. In almost all cases, no serious aftereffects occur from these perforations, as the needle used is thin. Still, there are case reports of bleeding from organ perforations that require surgical intervention. Other examples of risks involved with culdocentesis are infection and bleeding from the puncture site.
Bibliography
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Rock, John A., et al., eds. Te Linde’s Operative Gynecology. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2011.
Stenchever, Morton A., et al. Comprehensive Gynecology. 5th ed. St. Louis, Mo.: Mosby, 2007.
Vorvick, Linda J. "Culdocentesis." MedlinePlus, February 26, 2012.