Puncture the posterior fornix of the vagina — culdocentesis
In the female body Douglas has a small space located between the uterus and the anterior wall of the rectum. Some diseases are characterized by accumulation of fluid in this space. Receive the exudate from the abdominal cavity through a back vault of the vagina is called culdocentesis. Using culdocentesis can determine the nature of the liquid in papadimitrou space and put the correct diagnosis for many diseases.
Brief description of the manipulation
The procedure is performed in a stationary mode to determine the presence of fluids in the pelvic cavity. Conducting culdocentesis involves the use of local anesthesia. In some cases requires General anesthesia.
Puncture of abdominal cavity is made through the posterior fornix of the vagina. The thus obtained liquid (blood clots, pus, serous fluid) is sent to the laboratory for Cytology or bacteriological examination. According to the results it is possible to diagnose the development of bleeding, inflammation in the peritoneum or pelvis, up to the diagnosis of ovarian cancer at an early stage.
The use of this method allows to confirm the diagnosis in many diseases in the gynecological field. The most common indications for puncture of the uterus are:
- suspected ectopic pregnancy;
- apoplexy of the ovary;
- ruptured ovarian cyst;
- tumours of the ovary;
- definition of exudative nature of the fluid, provided that there is no suspicion of their malignancy;
- the removal of the inflamed fluid;
- pre-surgery before the procedure of colpotomy in posterior parametritis or colorelite, which is held in abscess of the recto-uterine recess.
According to the results of the conducted research it is possible to speak about the appointment of medical drugs and the need for surgery.
Preparing for surgery
As with any gynecological intervention procedure requires little training:
- eliminate gels and ointments, are intended for vaginal use;
- shave hair in the pubic area and labia;
- do not eat for 10-12 hours before the procedure;
- to completely empty the bladder, the rectum; in the case of the need for a cleansing enema.
After the preparatory phase, a woman goes to the hospital for the procedure culdocentesis.
A set of tools for the procedure
To perform the puncture of a core set of medical instruments includes: bullet forceps, mirror legkoobratimy, needle length 12 cm with an oblique cut tip syringe 10 ml, forceps.
The sequence of the procedure
Puncture the posterior fornix of the vagina is a painful procedure. Before its implementation required a full evacuation of the bowel and bladder.
The whole procedure is performed under local anesthesia, which is often used with lidocaine. Anesthesia allows to reduce the sensitivity to pain, which results in less muscle tension required for correct insertion of the needle.
The whole medical procedure takes place in several stages:
- Lay the patient on the gynecological chair. To Immobilise the leg using locking bands or belts. It is important to maintain the correct posture during the operation.
- Before beginning the procedure manual to conduct a study to determine the position of the uterus and the posterior fornix of the vagina and the direction of movement of the needle.
- The vulva and vagina to expose the antiseptic treatment.
- Expose the cervix with the lift to take her to the pubic symphysis. Thus, the back wall of the vagina that will hold the fence material. For removing the cervix using special tongs.
- The future site of the puncture anesthetize 1 – 2% lidocaine.
- As the anesthesia thick injection needle piercing the posterior vaginal vault, removing accumulated fluid from a Douglas space. The needle is introduced in the midline to a depth of 2 cm. the Needle is directed horizontally or with a slight deviation upwards. This is necessary in order to prevent perforation of the rectum and blood vessels.
- At a puncture of there is a feeling of dropping the needle into the void. If that happens, you need to choose another place to puncture.
- Once in a Douglas space, carefully pull the plunger of the syringe itself. Punctate by dialling into a syringe that can be monitored visually.
- The resulting fluid is sent for cytological and bacteriological examination, the results of which are necessary for further medical interventions.
Cytological study of free fluid within the abdominal space is the basic method for determining ectopic pregnancy. When you terminate an ectopic pregnancy resulting material will contain dark liquid blood. Perhaps the emergence of some blood clots in the syringe.
When the fence material sometimes have to face certain difficulties: suction tissue to cut needle or injected into the lumen of the needle clots. In this case, requires the introduction of isotonic solution of sodium chloride in the Douglas space, followed by extraction of fluid. The resulting material is also placed a sterile container and sent to a testing laboratory.
Punctate purulent contents would indicate the development of inflammation. At suspicion on the abscess of the uterine appendages antibiotics administered. Therapeutic manipulation is carried out after removing exudative fluid from the abdominal cavity.
Complications after the procedure
Negative consequences after culdocentesis are rare. Basically, they are the result of incorrect location of the needle when introducing it in the rear arch: puncture of the vessel or of the rectum. Special therapy is required, but you may experience discomfort in the pelvic area, accompanied by pain of a different nature.
When severe pain or bleeding, you must consult a doctor.