DESCRIPTION

Culdocentesis is a procedure that checks for abnormal fluid by inserting a long, thin needles through the "cul-de-sac" (French for "bottom of [a] sack") vaginal wall (the rectouterine pouch called the pouch of Douglas) located in the space deep in the vagina behind and under the cervix. A sample is taken of any fluid found in the space and the needle is then withdrawn.

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REASONS FOR PROCEDURE

This procedure is done when pain occurs in the lower abdomen and pelvic regions, and other tests suggest that fluid may be present in the cul-de-sac. This tests is now performed infrequently because of the availability and effectiveness of ultrasound examinations to detect fluid in the cul-de-sac. Investigation of possible ailments in the abdomen and pelvis include:

• Bleeding inside the lower pelvic cavity.


• Ruptured Ectopic Pregnancy.


• Ruptured Ovarian Cyst.


• Ovarian Cancer.


• Pelvic Inflammatory Disease (PID).

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RISK

Recent or chronic illness may increase risk.

There is a slight risk of puncturing any mass, cyst, or ectopic pregnancy that exists. The needle should not be inserted too far or with such firmness that it penetrates the uterine wall.

CONTRAINDICATIONS

Prior to the procedure, a bimanual exam should be performed to ascertain that the cul-de-sac does not contain cysts, masses, or other structures that might contaminate the peritoneal cavity if perforated or that could impede access to free fluid in the cul-de-sac. A fixed retroverted uterus or a bleeding diathesis are additional contraindications.

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DESCRIPTION OF PROCEDURE

INFORMED CONSENT

A consent form for culdocentesis should include the purpose of the procedure, explanation of what will happen in understandable terms, risks and complication, alternatives, and possible outcomes.

THE PROCEDURE

You may be asked to walk or sit for a short time before the test is done.

A speculum is inserted into the vagina to hold it open.

A pelvic exam is usually performed.

The rear lip of the cervix is grasped with an instrument raised slightly.

A local anesthetic may be applied to the farthest back portion of the vagina (cul-de-sac).

The posterior wall of the vagina is penetrated with a needle and syringe.

Fluid, if present, is aspirated. No sutures are necessary.

There may be an uncomfortable, cramping feeling when the cervix is grasped. There is a sharp brief pain as the needle is inserted.

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EXPECTED OUTCOME

A fluid sample is obtained successfully without complications in virtually all cases. If fluid or blood confirms other findings that suggest a serious disease or condition, you may need further surgery.

If no fluid is obtained and there are no complications, but you still have your original symptoms, expect further observation or tests to diagnose your condition. Allow about 1 week for recovery from the procedure.

TEST RESULT

Normal Values: No fluid in the cul-de-sac, or a very small amount of clear fluid, is normal.

Abnormal Results: Even when no fluid is found, it may be present, and other tests may be needed. If fluid is drawn, it is cultured to see if infection is present. If non-clotting blood is found in the cul-de-sac, emergency surgery may be required. An inadequate sample is a factor that can affect results.

If the test results indicate a possible ectopic pregnancy, a Laparoscopy may be performed to confirm the diagnosis and remove the fetus.

If an infectious agent is identified as the cause of PID, treatment with antibiotics can begin.

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POSSIBLE COMPLICATIONS

Perforation of bladder or bowel (rare).

Excessive bleeding.

Surgical wound infection.

POST PROCEDURE CARE

GENERAL MEASURES

You may need someone to take you home after the procedure if you were given a sedative.

Resume your usual activities as soon as possible.

Continue to use your usual birth control methods. Your periods should not be disturbed.

Use sanitary pads for your next menstrual period. Avoid tampons temporarily; they may lead to infection.

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MEDICATION

According to diagnosis.

You may use non-prescription drugs, such as acetaminophen, to relieve minor pain.

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ACTIVITY

Resume normal activities gradually. Resume sexual relations when able. This will depend on various underlying causes.

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DIET

No special diet. However, a nutritious dietary plan should be followed to build and maintain a healthy immune system and assist in healing.

MoonDragon's Nutrition Information, Guidelines, Dietary Recommendations



NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...

You experience vaginal bleeding that soaks more than 1 pad or tampon each hour.

Symptoms recur or worsen.

You have any signs and symptoms of infection: fever, body aches, headache, general ill feeling.

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