Сuldocentesis

In gynecology, there are diseases that cause fluid accumulation in the ectopic space. To confirm or refute the pathology, determine the cause of its development and perform differential diagnostics, a puncture of the vaginal vault is performed.

Diagnostic puncture of the posterior vault

Puncture through the posterior vaginal vault, or culdocentesis - a quick and safe diagnostic method that allows you to determine the nature of the fluid in the ectopic area (exudate) and establish the correct diagnosis. The procedure is very common in gynecology due to its high informativeness.

This instrumental and minimally invasive study is carried out to determine whether there is ascites in the abdominal space - a significant accumulation of pathological exudate, which can reach 20-30 liters. It is in the rectovaginal-uterine cavity, located between the posterior wall of the uterus and the anterior wall of the rectum, blood or pus can accumulate against the background of the pathological process.

Puncture of the posterior vault indications

• Suspicion of ectopic pregnancy, termination and the state after it;
• apoplexy, ovarian neoplasms;
• rupture of an ovarian cyst;
• suspicion of intra-abdominal bleeding or purulent-inflammatory processes;
• determining the nature of the exudative substance in the absence of suspicion of malignancy.

Analyzing the nature of the resulting discharge can be judged about the presence or absence of a pathological process, as well as the cause of its occurrence.

Contraindications to performing the procedure:

• inflammatory processes of the vagina or rectum;
• uterine cancer or large neoplasms in the pelvic cavity;
• ventral hernia, often occurring against the background of surgical interventions;
• blood coagulation disorders;
• pregnancy.

The decision to perform culdocentesis is made by the surgeon. He takes into account the results of examination and complaints of the patient, anamnesis, ultrasound data. Kuldocentesis indications and contraindications are an integral part of a comprehensive assessment of the woman.

Preparation for puncture

This diagnostic procedure requires certain preparatory actions on the part of the patient. A day before it should stop using intravaginal hygiene products (gels, ointments) or medications. In the area of the pubic area and labia should be removed hair. At least 10-12 hours should pass after the last meal. Immediately before the culdocentesis it is necessary to empty the bladder and rectum. If necessary, patients are prescribed an enema 2-3 hours before the operation.

Algorithm of the procedure of culdocentesis

Culdocentesis technique is not complicated, takes a little time and requires only professional actions of the doctor. Usually the procedure is performed with the use of local anesthesia to reduce pain sensitivity and reduce muscle tension.

The posterior vault puncture algorithm provides the following steps:

• The patient is placed on a gynecologic chair.
• The doctor performs a pelvic ultrasound and biomanual examination to familiarize himself with the anatomical features of organ placement.
• External genitalia are disinfected.
• Local anesthesia of the puncture site is performed.
• After the introduction of a gynecological mirror, the cervix is withdrawn with special forceps to the pubic symphysis. This opens access to the posterior wall of the vagina, which allows the material to be taken.
• A puncture needle or laparoscope trocar is inserted into the posterior vaginal vault.
• A long, thin injection needle is used to puncture an area slightly posterior to the border between the vault and the cervix. The needle is inserted to a depth of 2 cm. A syringe is used to slowly draw out the accumulated fluid.
• The material is given for cytologic and bacteriologic examination.

Then the doctor analyzes the results and decides on further medical actions.

Deciphering the results

Analysis of fluid from the abdominal cavity, containing dark liquid blood or its clots, will indicate an aborted ectopic pregnancy, the presence of ovarian apoplexy or other intra-abdominal bleeding. Detected pus indicates inflammation: purulent peritonitis, pyosalpinx or pyovar in the ovary.

Thanks to modern equipment and considerable experience of doctors of the medical network "Dobrobut" negative consequences of culdocentesis are few. In particular, it is possible to include getting clots in the lumen of the needle. In this case, the specialist introduces an isotonic solution of sodium chloride into the "abdominal pocket" and continues to withdraw exudate.  This is not dangerous and does not require special intervention. The main thing is to adhere to the doctor's recommendations.

Recovery period

A posterior vaginal puncture is usually tolerated normally by women. For a few days after the procedure, it is possible that unpleasant sensations may persist.

The patient should adhere to certain recommendations for a quick recovery:

• Limit the consumption of fatty, spicy, salty dishes, refined sweets and emphasize white meat, eggs, fermented milk products;
• drink no more than 1 liter of water per day;
• refuse physical exertion.

The duration of the rehabilitation period - several weeks or months - is determined by the doctor according to indications. Compliance with the advice of a specialist allows you to accelerate recovery and prevent the recurrence of excess fluid accumulation.