Culdocentesis is a procedure used to identify abnormalities in the female pelvis by collecting fluid from the rectum sac. It can determine the presence of pelvic inflammatory disease, an ovarian cyst, an ectopic pregnancy, or other complications. While ultrasound is now more commonly used, culdocentesis is still preferred in emergency situations or areas with limited access to diagnostic imaging equipment.
Culdocentesis is a clinical procedure used to identify abnormalities in the female pelvis. During the procedure, a plunger syringe is used to collect fluid from the rectum sac, a space located just behind the uterus in the lower abdomen. Based on the contents and quantity of the fluid sample retrieved, a doctor may be able to determine the presence of pelvic inflammatory disease (PID), an ovarian cyst, an ectopic pregnancy, or another type of complication. An ob-gyn, obstetrician, or licensed emergency physician can usually perform the outpatient procedure within minutes.
The rectouterine pouch, also called the cul-de-sac and pouch of Douglas, is located behind the vagina and above the rectum. It is the lowest part of a woman’s empty abdominal cavity. If there is a cyst, bacterial lesion, or other abnormality in the pelvis, fluid can leak out and build up in the pouch. Rarely, an ectopic pregnancy can occur when a fertilized egg inserts itself outside the uterus adjacent to the sac, leading to amniotic fluid buildup. Culdocentesis is an effective test to determine whether or not such problems exist.
Patients are usually given sedatives before undergoing culdocentesis to make them more comfortable. A localized anesthetic is also injected into the vagina to limit pain. To begin the procedure, the gynecologist uses a speculum to separate the vaginal walls for easier access. A syringe is then used to puncture the back of the vagina. Your doctor is careful when choosing a puncture site to avoid accidentally damaging your small intestine, rectum, or kidneys.
The plunger syringe is used to recover fluid, if indeed there is any. A dry sample usually indicates that there is no major complication, although your doctor may want to repeat the procedure to make sure you haven’t lost the fluid pool on the first try. If fluid is collected, it is sent to a laboratory for analysis. A large amount of clear fluid may indicate an ovarian cyst, while pus and thick yellow fluid are signs of bacterial infection. Amniotic fluid and thin, dark blood are typical findings of ectopic pregnancy.
Due to advances in diagnostic imaging technology, culdocentesis is not often performed in modern hospitals and gynecological clinics. Ultrasound machines can usually detect accumulations of fluid in the rectum pouch more accurately than culdocentesis procedures. Furthermore, ultrasound is non-invasive and poses almost no risk to the health of patients. Culdocentesis is still popular in areas of the world where access to diagnostic imaging equipment is limited. The procedure is sometimes preferred in emergency situations, such as suspected ruptures of ectopic pregnancies in the rectouterine pouch, in which it would take too much time to set up, administer, and interpret ultrasound.
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