Background Information:

What are the other Names for the Procedure?

• Colpoceliocentesis
• Colpocentesis
• Drainage of Cul-De-Sac by Aspiration

What is Culdocentesis surgical procedure?

The Culdocentesis procedure involves aspirating or withdrawing fluid from the cul-de-sac, which is the lower region behind the cervix and vagina, in the pelvis. The procedure is also known as Drainage of Cul-De-Sac by Aspiration.

What part of the Body does the Procedure involve?

A Culdocentesis procedure involves the vagina and part of the pelvis behind the cervix.

Why is the Culdocentesis surgical procedure Performed?

There could be various reasons for performing a Culdocentesis procedure. Some of these include:

• To diagnose disease or disorder of the pelvis
• Bleeding in lower pelvic cavity
• Ovarian cancer
• Ruptured cyst
• Inflammation of the pelvis
• Suspected rupture of ectopic pregnancy (a complication when the embryo is implanted outside the uterus)
• Ascites, which is an abnormal fluid collection in the abdominal cavity
• Pelvis abscess (pus collection in the pelvic cavity)

What are some Alternative Choices for the Procedure?

Imaging techniques (CT scan or Ultrasound) are sometimes used to diagnose the presence of fluid in the cul-de-sac region.

What are the Recent Advances in the Procedure?

Culdocentesis is not the best technique and is used only as an option when ultrasound or CT scan is not possible. Hence, there are no advancements to the procedure.

What is the Cost of performing the Culdocentesis surgical procedure?

The cost of Culdocentesis procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Culdocentesis procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/003919.htm (accessed on 24th July, 2012)

http://www.worldwidehealth.com/health-article-Endometriosis-Part-24-Diagnostic-Culdocentesis.html (accessed on 24th July, 2012)

Prior to Culdocentesis surgical procedure:

How is the Culdocentesis surgical procedure Performed?

A Culdocentesis procedure is performed as follows:

• The vagina is wiped with an antiseptic solution
• Then, a speculum is inserted in the vagina, to keep the vaginal cavity open. A speculum is an invasive instrument that aids in keeping the vaginal walls open
• Local anesthesia is applied around the area from where the fluid will be aspirated
• A syringe is inserted and penetrated through the posterior side of the wall of the cervix
• The fluid if present is withdrawn and sent for further lab examination

Where is the Procedure Performed?

A Culdocentesis procedure is usually performed in a hospital, an out-patient facility, or a well-equipped physician’s office. The individual can go home the same day, after the procedure.

Who Performs the Procedure?

A Culdocentesis procedure is performed either by an obstetrician, a gynecologist, or a general surgeon.

How long will the Procedure take?

The procedure may take anywhere between 30- 45 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any deodorant or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Culdocentesis procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Culdocentesis surgical procedure?

The individual has to undergo certain tests prior to a Culdocentesis procedure, such as:

• Routine blood and urine analysis
• Vaginal examination
• Abdominal examination
• X-ray of the lower abdomen
• CT scan
• Ultrasound

The physician may suggest further tests depending on the health of the individual and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Culdocentesis procedure?
• Why is this procedure necessary? 
• What does the procedure involve?
• How will this procedure help?
• Is it painful? How does the procedure feel?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Culdocentesis surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the individual is administered local anesthesia.

How much Blood will you lose, during the Procedure?

Since the procedure involves inserting a needle through the vaginal wall and is less invasive, there is little or no blood loss involved.

What are the possible Risks and Complications during the Culdocentesis surgical procedure?

The possible risks or complications that may arise during the surgery are as follows:

• Excessive bleeding
• Infection
• Puncturing the uterine wall or the bowel wall
• Accidental injury to the neighboring tissue or bone
• Perforation of bladder or bowel

What Post-Operative Care is needed at the Healthcare Facility after the Culdocentesis surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Culdocentesis surgical procedure:

What are the possible Risks and Complications after the Culdocentesis surgical procedure?

The possible risks and complications that may arise after a Culdocentesis are:

• Infection due to puncture
• Leakage of fluid into the uterus or bowel
• Urinary tract infection

What is the Prognosis after the Surgery?

• The Culdocentesis procedure provides information that helps the physician in successfully diagnosing or ruling out the presence of fluid in the abdomen. The presence of fluid generally implies a ‘disease’ condition
• However, please be informed that the procedure is generally not the best technique that can be used. It is only used as an option, when the use imaging techniques are impossible

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain
• Continuous bleeding through vagina
• Fever
• Dizziness
• Muscle ache
• Nausea or vomiting
• Signs of Infection
• If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after the Culdocentesis surgical procedure?

At home, the following post-operative care is recommended, after a Culdocentesis procedure:

• Complete the course of medication
• Avoid strenuous exercises
• Resume daily activity only after you feel better
• Avoid taking non-prescribed medications

How long does it normally take to fully recover, from the Procedure?

It takes about a week to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Culdocentesis surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, outpatient facility or physician’s office
• An obstetrician, gynecologist or general surgeon
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Culdocentesis procedure is performed. 

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA