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 that, in some cases, saves the patient's life.
Description of the technique
In the presence of inflammatory diseases or pathological formations in the female genital organs, culdocentesis can be prescribed. Indications may vary. The bottom line is that the specialist performs a puncture of the retrouterine cavity to take for examination the biological fluid accumulated there (pus, blood, other exudate).
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 betweenrectum and uterus in women. A special pocket is formed there, in which all the pathological fluid accumulates. Pathology can be examined with the help of an ultrasound or x-ray machine. 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 a reason for an emergency diagnosis. It is culdocentesis that makes it possible to differentiate various pathologies and determine the correct treatment.
The purpose of the manipulation
Culdocentesis - what is it? This is an opportunity to obtain fluid from the pouch of Douglas for an accurate diagnosis and appropriate treatment. An emergency study may be performed for any unclear cause of an acute abdomen. The technique can also be used in the following pathological conditions: ovarian cancer, suspicion of a malignant tumor, ectopic pregnancy, inflammation of the uterine appendages with the formation of exudate. As part of complex therapy, culdocentesis can be used for early diagnosis of ovarian carcinoma. The specialist receives a pathological fluid, studies its composition.
If there is a symptom of uterine fluctuation, a culdocentesis will also be performed. What is it in gynecology? This is a procedure for taking fluid from the Douglas space for examination. Pathology is determined during palpation by a qualified specialist. The bulging of the posterior fornix into the vagina during examination will also indicate the presence of pathologicalclusters.
When not to perform culdocentesis
The technique allows you to quickly determine the nature of the pathological fluid and start appropriate therapy. However, in some diseases, surgery can be harmful. So, it is absolutely impossible to perform a puncture if uterine cancer is suspected. A puncture can provoke metastasis, and the malignant process will begin to progress faster.
There are other conditions when culdocentesis cannot be prescribed. The technique for performing 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 infect the uterus.
Absolute contraindication for diagnostic testing is uterine retroflexion. This is an atypical structure of the organ, in which its body is bent towards the spine. Also, the procedure is not performed for pregnant women and women with vaginal obliteration.
Preparing for the procedure
We talked about a procedure called culdocentesis. What it is is now clear. Now let's learn how to prepare for it. Before a puncture, a woman must pass a series of tests: general blood and urine, blood for a coagulogram, for the determination of certain tumor markers (to rule out cancer), for the presence of HIV and hepatitis viruses. Also, the patient must do an ultrasound, MRI, ECG.
In most cases, manipulations are performed using the localanesthesia. General anesthesia can be prescribed for a difficult emotional state of the patient.
In order to avoid entering the infection into the study area, the external genitalia are treated with medical alcohol. A special mirror is inserted into the vagina, limiting the field for intervention. Next, the specialist marks the place where the puncture will be performed. As a rule, it is located on the lower fornix of the vagina.
Diagnostic procedure technique
To perform culdocentesis, a specialist needs the following tools: bullet forceps, puncture needle, spoon-shaped mirror and a 10 ml disposable syringe. The woman lies down in the gynecological chair in the standard position (as during a preventive examination). The posterior lip of the cervix is pulled up with bullet forceps. A puncture is performed on a pre-marked area. The doctor inserts the needle until a sensation of failure appears. As a rule, the working instrument is inserted to a depth of 1-2 cm. The specialist takes the contents from the pocket (pathological fluid) with a syringe and carefully removes the needle.
After all the instruments are removed from the vagina, the patient's genitals 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 can be performed even during the culdocentesis procedure. What it is? This means that in placetaking a puncture, a small incision is made through which purulent masses are removed. The cavity in which the abscess has formed is additionally treated with an antiseptic. The presence of pus is an indication for antibiotic therapy. Generally, broad-spectrum antibiotics are prescribed.
Ovarian culdocentesis is also considered a very effective diagnostic method. It is carried out 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 pain in the lower abdomen, in the area of the liver and / or kidneys.
Culdocentesis with an ovarian cyst 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 examination. It is important to find out what type of pathogen triggered the development of inflammation.
When taking a puncture, there may be blood in the syringe. Often this situation is observed with an interrupted ectopic pregnancy.
Culdocentesis is mandatory if a ruptured ovarian cyst is suspected. The contents of the syringe in this case will look like a serous fluid, sometimes with an admixture of blood.
Possible Complications
All sorts of negative reactions during the diagnostic procedure are quite rare. Troubles may appear if a woman does not follow the doctor's recommendations during manipulations orthe specialist himself has insufficient experience. Most often, during culdocentesis, there may be complications such as wounds with a uterine needle, intestinal trauma, or a needle entering a parametrial 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, bloody discharge from the vagina appears, this must be reported to the doctor.
In rare cases, after culdocentesis, women begin to develop adhesions in the pelvic area. However, the root cause of this pathological phenomenon is more often the underlying disease (inflammation of certain organs of the reproductive system).
Unpleasant complications will develop even if contraindications to diagnostic manipulations were not initially taken into account. An important role is played by the qualification of a specialist. Carrying out the procedure by 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 aimed at treating the identified pathological process.
Benefits of the procedure
Accumulation of fluid in the space of Douglas is the main indication for culdocentesis. The execution technique allows you to urgently make a diagnosis and start treatment when every minute counts. itthe main advantage of this type of research. According to some indicators, it is much more informative than MRI, ultrasound, x-rays and other diagnostic methods.
Flaws of the procedure
Unfortunately, culdocentesis has its drawbacks. If the puncture was performed several times, the risk of developing an adhesive process increases. After manipulations, the doctor should monitor the condition of the uterus. If the vessel is injured, an extensive hematoma may develop. For some time (about a month) after the diagnostic manipulations, it is impossible to have sex. Pregnancy can only be planned in a year.
