Culdocentesis is a procedure performed in women in which peritoneal fluid is aspirated from the posterior pelvic cul-de-sac (pouch of Douglas) through the posterior vaginal fornix. There are few indications for this procedure in current practice. Historically, it was used to evaluate women for hematoperitoneum or a pelvic infection. However, this role has largely been replaced by evaluation with pelvic imaging, image-guided aspiration of fluid, and minimally invasive surgery.
The culdocentesis procedure is reviewed here. Other approaches to the evaluation of women with suspected pelvic bleeding or infection are discussed separately. (See "Evaluation and management of ruptured ovarian cyst" and "Clinical features and diagnosis of pelvic inflammatory disease" and "Ectopic pregnancy: Clinical manifestations and diagnosis".)
Culdocentesis may be used to evaluate women with pain in the lower abdomen/pelvis to determine whether intraabdominal fluid is present and, if present, to reveal the nature of the fluid (eg, serous, purulent, bloody). Thus, the procedure can be helpful in evaluating women with a suspected ruptured ovarian cyst, pelvic inflammatory disease, or ruptured ectopic pregnancy [1-4]. (See "Evaluation and management of ruptured ovarian cyst" and "Clinical features and diagnosis of pelvic inflammatory disease" and "Ectopic pregnancy: Clinical manifestations and diagnosis".)
Ultrasound examination has largely replaced culdocentesis because it accurately identifies the presence of abdominal/pelvic fluid, is more comfortable for the patient, and provides additional information about the pelvis, such as whether there is an adnexal mass or intrauterine pregnancy. Findings on ultrasonography are especially useful when interpreted in conjunction with laboratory test results, such as a complete blood count and pregnancy test. However, culdocentesis may be useful when ultrasonography is not readily available.
Prior to the procedure, a bimanual examination should be performed to ascertain that the posterior cul-de-sac does not contain cysts, masses, or other structures that might contaminate the peritoneal cavity if perforated or that could impede access to free fluid in the posterior cul-de-sac. A fixed retroverted uterus or a bleeding diathesis are additional contraindications.