To make a correct diagnosis, doctors do not always have enough laboratory tests and non-invasive hardware studies. Often you have to resort to surgical interventions. In gynecology, a technique called “culdocentesis” is widely used. What it is? This is an emergency diagnostic method, which allows in some cases to save the patient's life.
Description of the technique
In the presence of inflammatory diseases or pathological formations of the female genital organs, culdocentesis can be prescribed. Indications may be different. The bottom line is that the specialist carries out a puncture of the lateral recess for taking the biological fluid accumulated there (pus, blood, other exudate) for examination.
With the development of inflammation or other gynecological pathology, the fluid that forms accumulates in the so-called Douglas space. This is the largest depression in the abdominal cavity that exists between the rectum and the uterus in women. A special pocket is formed there, in which all the pathological fluid accumulates. Pathology may well be considered with the help of an ultrasound machine or x-ray. However, it is possible to find out what kind of liquid it is only with the help of culdocentesis.
The presence of any fluid in the Douglas space is an occasion for emergency diagnostics. It is culdocentesis that allows differentiating various pathologies and deciding on the right treatment.
The purpose of the manipulation
Culdocentesis - what is it? This is an opportunity to get fluid from the Douglas space for an accurate diagnosis and appropriate treatment. An emergency study can be performed for any unclear cause of an acute abdomen. The technique can also be used in the following pathological conditions: ovarian cancer, suspected malignant tumor, ectopic pregnancy, inflammation of the uterus with the formation of exudate. As part of complex therapy, culdocentesis can be used for early diagnosis of ovarian carcinoma. The specialist receives pathological fluid, studies its composition.
If there is a symptom of uterine fluctuation, culdocentesis will also be performed. What is gynecology? This is a procedure for taking fluid from a Douglas space for examination. Pathology is determined by palpation by a qualified specialist. The pushing of the posterior fornix into the vagina during examination will also indicate the presence of pathological accumulations.
When you can not perform culdocentesis
The technique allows you to quickly determine the nature of the pathological fluid and begin appropriate therapy. However, for some diseases, surgery can be harmful. So, categorically it is impossible to perform a puncture in cases of suspected uterine cancer. A puncture can provoke metastasis, and the malignant process will begin to progress more quickly.
There are other conditions when culdocentesis cannot be prescribed. The technique of the procedure is quite aggressive. A puncture can provoke a rapid spread of infection. Such a study is not carried out in the presence of inflammatory processes in the vagina, so as not to bring the infection into the uterus.
An absolute contraindication for a diagnostic study is uterine retroflexion. This is an atypical structure of the organ, in which his body bends towards the spine. Also, the procedure is not performed for pregnant women and women who have vaginal obliteration.
Preparation for the procedure
We talked about a procedure called culdocentesis. What it is is now clear. Now we will learn how to prepare for it. Before the puncture, a woman must pass a series of tests: total blood and urine tests, blood for a coagulogram, for the determination of some tumor markers (to exclude cancer), for the presence of HIV and hepatitis viruses. Also, the patient should do an ultrasound, MRI, ECG.
In most cases, manipulations are performed using local anesthesia. General anesthesia can be prescribed for the patient’s complex emotional state.
In order to avoid entry into the studied area of infection, the external genitalia are treated with medical alcohol. A special mirror is inserted into the vagina, limiting the field for intervention. Next, the specialist notes the place where the puncture will be performed. As a rule, it is located on the lower vault of the vagina.
Technique for the diagnostic procedure
To carry out culdocentesis, a specialist needs the following tools: bullet forceps, a needle for performing a puncture, a spoon-shaped mirror and a 10 ml disposable syringe. A woman lies in a gynecological chair in a standard position (as during a routine examination). The back lip of the cervix is pulled with bullet forceps. Puncture is performed on the previously marked site. The doctor introduces the needle until a sensation of failure appears. As a rule, a working tool is inserted to a depth of 1-2 cm. A specialist takes a contents from a pocket (pathological fluid) with a syringe and carefully removes the needle.
After all the instruments are removed from the vagina, the genitals of the patient are once again treated with an antiseptic. The resulting liquid is sent to the laboratory for a thorough study.
results
If pus is found in the biomaterial, drainage of the douglas space may be carried out during the culdocentesis procedure. What it is? This means that a small incision is made at the puncture site, through which purulent masses are removed. The cavity in which the abscess formed is additionally treated with an antiseptic. The presence of pus is an indication for antibiotic therapy. As a rule, broad-spectrum antibiotics are prescribed.
Culdocentesis of the ovary is also considered a very effective diagnostic method. It is performed with the formation of cysts on the ovary. This manipulation is quite common and is performed when the follicle reaches a size of more than 16 mm. Other indications for taking a puncture are severe pains in the lower abdomen, in the region of the liver and / or kidneys.
Culdocentesis in ovarian cysts may have the goal of freeing the follicle from the fluid that filled it. The procedure is performed only on an empty stomach.
The taken liquid is transferred to the laboratory for bacteriological research. It is important to find out exactly what type of pathogen provoked the development of inflammation.
When taking a puncture, blood may be present in the syringe. Often this situation is observed with an interrupted ectopic pregnancy.
Culdocentesis must be performed if there is a suspicion of rupture of an ovarian cyst. The contents of the syringe in this case will look like serous fluid, sometimes with an admixture of blood.
Possible complications
All kinds of negative reactions during the diagnostic procedure occur quite rarely. Troubles may occur if a woman does not follow the doctor's recommendations during the manipulation or the specialist himself has insufficient experience. Most often, during culdocentesis, there may be complications such as injuries to the uterine needle, intestinal trauma, and a needle falling into a parametric vessel.
A woman feels pain if anesthesia has not been performed.
It is worth remembering that after the procedure, the patient's condition should not worsen. If all the manipulations were carried out correctly, there will be no bleeding. If, after the diagnostic procedure, spotting from the vagina appears, you should definitely inform your doctor about this.
In rare cases, after culdocentesis, adhesions in the pelvic area begin to develop in women. However, the underlying cause of this pathological phenomenon is often the underlying disease (inflammation of various organs of the reproductive system).
Unpleasant complications will develop in the event that contraindications to diagnostic procedures were not initially taken into account. An important role is played by the qualification of a specialist. Carrying out the procedure with an experienced doctor is a guarantee of a successful outcome.
Special rehabilitation after the culdocentesis procedure is not carried out. Further actions of the doctor will be directed to the treatment of the revealed pathological process.
Procedure benefits
The accumulation of fluid in the Douglas space is the main indication for culdocentesis. The technique of execution allows you to urgently make a diagnosis and begin treatment when every minute counts. This is the main advantage of this type of research. According to some indicators, it is much more informative than MRI, ultrasound, X-ray and other diagnostic methods.
Disadvantages of the procedure
Unfortunately, it has a culdocentesis and its drawbacks. If the puncture was performed several times, the risk of developing adhesions increases. After the manipulations, the doctor should monitor the condition of the uterus. When a vessel is injured, an extensive hematoma can develop. For some time (about a month) after carrying out diagnostic procedures, it is impossible to have a sexual life. Pregnancy can be planned only after a year.