What does culdocentesis mean?
Culdocentesis is the puncture and aspiration (withdrawal) of fluid from the pouch of Douglas or rectouterine pouch. The pouch of Douglas or rectouterine pouch is formed between the part of the gut and the uterus. The procedure involves the introduction of a needle through the vaginal wall into the pouch of Douglas. Blood, pus and other fluids in the abdominal cavity collect in the pouch because of its dependent location and gravity. It may be examined to diagnose diseases of the abdomen.
Culdocentesis used to be a valuable procedure for the diagnosis of ectopic pregnancy. However, due to the development and easy access to ultrasound (USG), culdocentesis is rarely performed.
An ectopic pregnancy occurs when the fertilized egg or embryo implants and grows outside the uterus, most commonly in a fallopian tube (the tube that carries the eggs from the ovaries to the uterus). This is called a tubal pregnancy. The results of culdocentesis may sometimes be deceptive, resulting in unwarranted reassurance or unnecessary treatment.
When is culdocentesis done?
Although culdocentesis is rarely performed now due to the widespread availability of ultrasound, the procedure is performed
- To diagnose suspected or ruptured ectopic pregnancy if the patient is unstable and ultrasonography or laparoscopy is not readily available.
- To diagnose hemoperitoneum (bleeding into the peritoneal cavity) after blunt trauma to the abdomen or abdominal surgery.
- For the diagnosis of ruptured ovarian cysts.
- For the diagnosis and drainage of pus in pelvic inflammatory disease (PID).
- For the diagnosis and treatment of ascites (fluid accumulation of abdominal cavity).
When should culdocentesis not be done?
Culdocentesis may be contraindicated in the following conditions
- Pelvic tumors, including the ovaries
- Abscesses in the pelvis
- Anatomical deformities of the uterus, such as the retroverted uterus
- Bleeding disorders
- Prepubescent women because the prepubescent vagina is smaller and it would be difficult to perform the procedure through a small vagina
- A noncooperative or anxious patient
How is culdocentesis performed?
Prior to culdocentesis, the patient is asked to stand or sit up straight for some time so the peritoneal fluid can pool in the pouch. The procedure is performed under local anesthesia. Local anesthetic, usually lidocaine, is injected into the vaginal lining. A vaginal speculum is inserted into the vagina to widen it. A spinal needle is inserted through the vagina into the pouch of Douglas. The fluid is aspirated and the physical appearance is studied and sent for testing. Postprocedural pain can be managed with painkillers and antibiotics may be prescribed.
What are the complications of culdocentesis?
Though rare, some possible complications of culdocentesis include
- Rupture of abscess in the pelvis causing the spread of infection
- Puncture of the bowel or pelvis
- Bleeding from the puncture site or due to injury to major pelvic blood vessels
- Puncture of malignant ovarian cysts, causing the spread of cancer throughout the abdominal cavity
- Rupture of a tubal pregnancy (implantation of the fertilized egg in the fallopian tube instead of the uterus)
- Injury to intrauterine pregnancy due to the needle
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