CULDOCENTESIS

General Information

DEFINITION--Piercing the "cul-de-sac," the space deep in the vagina behind and under the cervix.

BODY PARTS INVOLVED--Vagina; lowest part of pelvis behind the uterus and cervix.

REASONS FOR SURGERY--Investigation of possible ailments in the abdomen and pelvis, including: bleeding inside the lower pelvic cavity; ruptured ectopic pregnancy; ruptured ovarian cyst; ovarian cancer; or pelvic inflammatory disease. Laboratory examination of the removed fluid aids in diagnosis.

SURGICAL RISK INCREASES WITH--Recent or chronic illness.

What To Expect

WHO OPERATES--Obstetrician-gynecologist, general surgeon or family doctor.

WHERE PERFORMED--Doctor's office; outpatient surgical facility; or hospital.

DIAGNOSTIC TESTS

• Before surgery: Pap smear; vaginal and abdominal exam; x-rays of lower abdomen.
• After surgery: Laboratory examination of removed fluid.

ANESTHESIA--Local anesthesia by injection.

DESCRIPTION OF OPERATION

• A speculum is inserted into the vagina to hold it open.
• The rear lip of the cervix is raised.
• A local anesthetic is 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.

POSSIBLE COMPLICATIONS

• Perforation of bladder or bowel (rare).
• Excessive bleeding.
• Surgical-wound infection.

AVERAGE HOSPITAL STAY--Usually none.

PROBABLE 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 conditions.
• Allow about 1 week for recovery from the procedure.

Postoperative Care

† 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.

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

ACTIVITY---Resume normal activities gradually. Resume sexual relations when able. This will depend on various underlying causes. Ask your doctor.

DIET---No special diet.

Call Your Doctor If

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

• Symptoms recur or worsen.