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October 31, 2014  
EDUCATION CENTER: Diagnostics
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  • Culdocentesis


    Overview:
    Culdocentesis is a procedure performed to check for abnormal fluid in the space behind the vagina. The procedure involves the insertion of a needle through the vaginal wall to draw off a sample of any existing fluid and analyze its composition.

    Detailed Information:
    A culdocentesis may be recommended for women experiencing pain in the lower abdominal or pelvic area. The test allows doctors to check for and evaluate the nature of fluid in the "cul-de-sac," a space in the abdominal cavity that is located behind the vagina and between the rectum and uterus, which may also be called the rectouterine pouch or the pouch of Douglas.

    Before beginning the test, a pelvic examination is done, during which the inside of the vagina is examined, and the uterus is palpated through the abdomen and from within the vagina (the "bimanual examination") to check for any abnormalities or changes since the last exam. Patients may also be asked to walk around or sit in an upright position for several minutes to ensure that any fluid in the area has drained to the lowest area of the cul-de-sac, allowing for sampling.

    The patient may also be given a local anesthetic, a mild sedative, or both, to ease discomfort during the procedure. Since patients generally experience an uncomfortable cramping sensation when the cervix is grasped and lifted and a sharp pain when the needle is inserted through the vaginal wall, many doctors do recommend some form of anesthesia or sedation. It is important for patients to speak to doctors or health care providers about the positive and negative effects of anesthesia or sedation in conjunction with this procedure.

    Once any anesthesia or sedatives have taken effect, a medical instrument is used to grasp and lift the cervix, to expose the area where the needle will be inserted. A needle attached to a syringe is then inserted through the vaginal wall, just below the cervix, and into the cul-de-sac. A sample of any fluid in the area is drawn into the syringe, and the needle is removed from the area.

    If there is little fluid or a small amount of clear fluid in the cul-de-sac, this is a sign of general health in the area, but if the fluid contains pus, blood, or is otherwise abnormal, this may be evidence of a ruptured ectopic pregnancy or ovarian cyst. In the case of a cyst, the pus must be drained. If there is unclotted blood found in the cul-de-sac, this may be a sign of excessive bleeding (hemorrhaging) in the area, which can indicate a serious rupture or infection that would require immediate treatment. Antibiotics may be prescribed to treat any infection in the area.

    If culdocentisis does not indicate any medical condition requiring treatment, patients can generally resume normal activities as soon as any sedation has worn off, or immediately after the procedure in the case that there was no sedation. In the case that culdocentesis does expose a medical problem or illness, immediate treatment – occasionally including surgery – may be required in the following hours or days, depending on the severity of the problem. Doctors may administer other tests if more information is needed for a conclusive diagnosis.

    While culdocentesis was formerly the only way to test for abnormal fluid in the cul-de-sac, breakthroughs in ultrasound technology have made it possible to use ultrasound (a range of sound waves that can be translated into an image with the help of special equipment) to explore the area with much greater comfort, as well as improved accuracy. Today, the test is generally performed only in the case that ultrasound cannot provide a specific enough diagnosis.

    Last updated: 06-Jun-07


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