Puncture of the abdominal cavity through the posterior fornix, technique, indications. Puncture of the abdominal cavity through the posterior vaginal fornix Pelvic puncture how to do it

Modern medicine offers quite a lot of diagnostic procedures that can help in making the correct diagnosis. Some of them are considered relatively simple and do not require special efforts or lengthy preparation from either the patient or the doctor. Other studies are complex and quite uncomfortable, but, nevertheless, in some cases you cannot do without them. One of the possible diagnostic manipulations is puncture abdominal cavity through the posterior fornix, the technique of this procedure and indications for its implementation will be the topic of our conversation today.

Puncture of the abdominal cavity through the posterior vaginal fornix is the closest and most convenient way reach the pelvic cavity (rectal recess, pouch of Douglas). It is in this area that fluid (pus, blood, exudate) accumulates under many conditions. pathological conditions, in most cases of gynecological etiology.

Abdominal puncture through the posterior vaginal fornix is also called culdocentesis. This study carried out in the inpatient department, if necessary, to identify the presence or absence of any free fluids in the pelvic cavity. The resulting blood, pus or serous fluid is then sent to bacteriological examination And cytological analysis, which allows you to make the diagnosis as detailed as possible.

When is puncture of the abdominal cavity through the posterior fornix possible, what are the indications for it?

Puncture of the abdominal cavity through the posterior vaginal fornix is carried out:

If you suspect the presence of free fluids inside the pelvic cavity;
- to clarify the diagnosis of possible ectopic pregnancy, inflammatory lesions of the uterine appendages, rupture cystic formation or breakthrough of the abscess (with blurred clinical manifestations);
- to confirm or refute the diagnosis of ovarian cancer.

Technique for abdominal puncture through the posterior fornix

Puncture of the abdominal cavity through the posterior vaginal fornix is carried out, as we have already found out, in conditions inpatient department. At the same time, doctors take measures to comply with all the rules and regulations of asepsis and antisepsis. Before carrying out this intervention, it is extremely important to empty the bladder and bowels.

Mask (oxygen or fluorotane, etc.) anesthesia can be used as anesthesia. In some cases, doctors resort to intravenous anesthesia or local anesthesia using a solution of novocaine (0.25% 5-10 ml).

To perform a puncture of the abdominal cavity through the posterior vaginal fornix, a thick needle is used (its length is ten to twelve centimeters), it is placed on a ten-gram syringe.

The patient is placed on a gynecological chair. All external genitalia, as well as the vaginal cavity and cervix, are disinfected using alcohol and a one percent solution of iodonate. Next, a back speculum and a lift are used to expose the vaginal part of the cervix. She is grabbed by the back lip with bullet forceps. Afterwards, the specialist removes the lift and hands the rear mirror to an assistant. Pulling the uterine cervix toward you using bullet forceps, the doctor simultaneously presses on the area back wall vagina. This allows you to stretch the posterior arch as much as possible.

Under the uterine cervix, the doctor steps back exactly a centimeter from the area where the fornix transitions into the vaginal area of the cervix. The specialist moves exclusively according to midline. At this point, a needle is inserted through the posterior fornix, and it is deepened two to three centimeters. After the needle pierces the arch, there is a feeling of falling into the void. Next, the doctor pulls the syringe plunger towards himself, and the liquid is easily drawn into the syringe.

If this does not happen, the specialist can slowly and carefully push the needle deeper or, conversely, also slowly remove it, while simultaneously pulling the syringe plunger towards himself.

The resulting punctate is carefully examined, determining its features - character (blood, serous fluid, pus), color and smell. If there are indications, a bacteriological, biochemical or cytological examination of the obtained material is carried out.

If an ectopic pregnancy has been terminated, the puncture will look like liquid blood dark color. Small dark blood clots are visible on a white napkin.

Additional Information

Interpretation of the results of puncture of the abdominal cavity through the posterior vaginal fornix is carried out exclusively by a qualified specialist who takes into account all factors that can affect the study data.

In some cases, culdocentesis can provide false positive results– if the needle enters a vessel of the parametrium, vagina or uterus.

In addition, such a study may be false negative - if a defect in the needle lumen is observed, a small amount of blood accumulates inside the abdominal cavity or there is a pronounced adhesive process in the area of the uterine appendages.

Blood can be detected not only during termination of an ectopic pregnancy, but also during ovarian apoplexy, a ruptured spleen, and also during reflux menstrual blood or soon after curettage of the uterine cavity.

Accordingly, instead of puncture of the abdominal cavity through the posterior vaginal fornix, laparoscopy is often performed.

Puncture posterior arch vagina- this is the most convenient and closest access to the pelvic area, where fluids such as blood, pus, exudate, etc. accumulate during various pathological and gynecological processes.

Puncture of the posterior vaginal vault is surgical intervention and is carried out in a hospital.

The procedure is carried out in cases of determining the presence or absence of blood, pus, serous fluid in the pelvic cavity. The resulting liquid for diagnosing the inflammatory process in the pelvic cavity or early diagnosis ovarian cancer is sent for cytological and bacteriological examination.

Puncture of the posterior vaginal fornix also used to confirm or exclude diagnoses of diseases internal organs, including:

rupture of the uterus or other internal organs;
ectopic pregnancy, pelvioperitonitis or general peritonitis;
to determine the nature of the exudate of saccular tumors fallopian tubes and ovaries of non-malignant origin.

The procedure is carried out in therapeutic purposes: for introduction antibacterial drugs or suction of inflammatory exudate; preliminary operation before colpotomy or before colpoceliotomy.

Puncture of the posterior vaginal fornix is a very painful operation. Preoperative preparation is that first of all it is necessary to empty the rectum and bladder.

Before the operation, the external genitalia and vagina are treated with 70% ethyl alcohol and iodine.

Method of manipulation during surgery

Without grasping with forceps, the cervix is exposed and retracted with a lift to the pubic symphysis.

This allows the back of the vaginal vault to stretch between the speculum and the lift. Before the puncture, the puncture site is numbed with lidocaine solution. Some time after the anesthesia has taken effect, a long injection needle is used to pierce the back the vaginal vault and suck out the liquid present in the rectal uterine cavity. The needle is inserted to a depth of two centimeters.

During the puncture, the needle should be directed horizontally or slightly upward so as not to damage the rectum. The reverse movement of the piston, simultaneously with the slow withdrawal of the needle, removes the liquid, then conducts its bacteriological and cytological examination.

To confirm the diagnosis ectopic pregnancy defibrinated blood is sucked out. But this does not always work out, since this blood quickly clots and the needle is thrombosed by a blood clot. This clot is pushed out with a syringe onto a gauze pad and tested in the same way as with blood, since this is enough to confirm an ectopic pregnancy. If the blood that gets into the syringe is thick and dark with clots, this is also an indicator of an ectopic pregnancy.

Blood is also detected when the spleen ruptures, ovarian apoplexy, and also after curettage of the uterus.

Puncture of the posterior vaginal vault is also used if an abscess of the uterine appendages is suspected. In this case, when the pus is sucked out, antibiotics are injected into the cavity of the purulent tumor.

Complications after puncture of the posterior vaginal vault

Complications during puncture are extremely rare, although punctures of a vessel or vagina are possible. Uterus, intestinal injury, etc., but all this does not require special treatment.

The puncture is performed in compliance with the rules of asepsis and antiseptics. First check how tightly the needle is seated on the syringe (it does not slip off and does not allow air to pass through). A spoon-shaped speculum and a lift are inserted into the vagina. The cervix is exposed. The posterior lip is grabbed with bullet forceps and pulled anteriorly (towards the symphysis). The vaginal walls are pulled back. A long needle (12-14 cm) with a wide lumen, beveled at the end and put on a 10-gram syringe, is inserted into the stretched posterior fornix along the midline, between the uterosacral ligaments. The needle is inserted with a short decisive push 2-3 cm deep. If the tumor is separated from the vaginal wall by a layer of denser infiltrate, then the needle is inserted somewhat deeper. The direction of the needle is horizontal or slightly anterior (parallel to the wire axis of the pelvis). Slowly remove the syringe plunger.

If there is no content in the syringe, carefully remove the needle (along with the syringe), continuing suction.

The paragraph may appear in last minute(the needle passed above the liquid level or rested against hard fabric etc.). If the vagina is very narrow, puncture can be performed without speculums. The index and middle fingers of the left hand, place them under the neck in the area of the uterosacral ligaments. Using the bases of the fingers, the perineum is pulled downwards. The needle is passed between the palmar surfaces of the fingers inserted into the vagina.

A puncture through the anterior fornix is unacceptable (the bladder is pierced); it is not recommended to puncture through the lateral fornix (possibility of injury to the uterine vessels and ureter).

Complications during puncture of the posterior vaginal vault

Puncture of the uterine vessels. In a syringe dark liquid no clots. At heavy bleeding resort to dense vaginal tamponade.

IN modern medicine there are many most different ways diagnostics that can quickly and accurately confirm or refute the suspected diagnosis. Some techniques are simple and do not require any special preparation from patients. Moreover, the procedures themselves are carried out quickly, without any effort. Other methods can cause discomfort, but it is impossible to do without them. One of these manipulations is puncture of the posterior vaginal fornix.

Features of the procedure

Puncture of the posterior vaginal vault has its own characteristics. It is carried out for diagnostic purposes to identify the contents of the rectouterine cavity. Less commonly, this procedure is performed as an auxiliary procedure.

Puncture of the posterior vaginal fornix requires anesthesia. Patients are given short-term anesthesia or local conduction anesthesia.

For diagnosis to be effective, the patient must lie down so that her pelvis is downward. This position helps to drain even a small number fluid located in the rectal-uterine zone. This greatly increases the effectiveness of the manipulation.

Indications

Puncture of the posterior vaginal fornix is used in case of suspicion of other internal organs, as well as:

if you suspect the presence of any type of fluid in the pelvis;
administer medications if necessary;
if you suspect ovarian cancer;
upon breakthrough purulent pathologies into the abdominal cavity.

Puncture through the posterior vaginal fornix allows you to accurately determine the presence of fluid and its type without surgical intervention.

Where is the procedure performed?

The manipulation is carried out only in a hospital, since it is surgical appearance interventions. During the procedure, all rules of antiseptics and asepsis are observed. Before the puncture is performed, the patient must empty her bladder and bowels. For these purposes, a cleansing enema may be prescribed.

Most often, nitrous oxide or any other mask anesthesia is used for anesthesia. General intravenous anesthesia and local anesthesia in the form of a solution of novocaine.

How is it carried out?

Puncture of the abdominal cavity through the posterior vaginal fornix is performed with a long, thick needle. Its size is more than ten centimeters. The needle is placed on a 10- or 20-gram syringe.

The patient is positioned in After placement, doctors treat the woman’s external genitalia. Typically, a solution of iodonate is used for this. A speculum and a lift are then inserted into the vagina to help determine the location of the cervix. The doctor grabs the organ by the back lip with forceps. After this, the lift is removed and the mirror is handed over to the assistant.

The doctor makes a puncture under the cervix with a needle. It is performed by stepping back a few centimeters from the junction of the vagina and the cervix. At the selected location, the needle is inserted into the abdominal cavity. During the puncture, the specialist feels how the instrument for puncture of the posterior vaginal vault has entered the void. Then the doctor pulls the piston towards himself. If there is liquid in the recess, it begins to flow into the syringe.

Liquid and its meaning

The item is examined to determine its character. As a result of the procedure, blood and pus may be detected. According to indications, a bacteriological, cytological or other type of analysis of the resulting fluid is performed.

If purulent contents appear, the doctor may suspect rupture of the abscess, peritonitis. The presence of pathological contents may indicate an abscess of the uterine appendages.

If there is blood in the depression, this indicates bleeding. It can be caused by a rupture of the fallopian tube during an ectopic pregnancy. In this case, the blood has a dark color mixed with clots. It can also fall into the recess due to a rupture internal vessel. In this case, it quickly collapses.

There are times when the doctor is unable to get the fluid, although it is present in the cavity. This version of the procedure is due to the fact that the needle becomes clogged with a blood clot. In order for the doctor to get a result, he must remove the needle and push the clot out of it with air. This is usually done on a napkin so that the presence of blood can be determined. If a clot is obtained and there is no blood in the syringe barrel, then even this will be enough to suggest an ectopic pregnancy.

It happens that it is not possible to suck out the liquid from the cavity because the density is too high. In this situation, a sterile sodium chloride solution is injected into the cavity to dilute the fluid. In this more liquid state, the solution is easily collected and transferred to the laboratory for analysis.

After manipulation

At the end of the procedure, the set used for puncture of the posterior vaginal vault is disinfected. If a disposable instrument was used, it should be disposed of.

After surgery, patients can go home. Complications after puncture occur extremely rarely.

Blood can be detected not only during ectopic pregnancy, but also during other pathological conditions. For example, it appears with ovarian apoplexy, rupture of the spleen, menstrual blood entering the fornix and other types of pathologies.

If purulent contents are revealed during the puncture, the doctor will suck it out and inject an antibiotic into the cavity.

Puncture is an informative procedure performed not only for diagnostic purposes, but also for therapeutic purpose. Through a puncture, the doctor can quickly inject medicine exactly to the affected area.

Biopsy and histological examination the resulting tissue allows us to clarify the character pathological process cervix, vagina and external genitalia. Preparation for surgery is the same as for diagnostic curettage. Compliance with asepsis and antiseptics is mandatory.

Kit necessary tools: spoon-shaped mirrors, forceps, tweezers, bullet forceps (2), scalpel, scissors, needle with needle holder, catgut. Sterile material, alcohol, and tincture of iodine are also needed.

The resulting piece of tissue is placed in a formalin solution and sent for histological examination with the appropriate direction.

If cervical cancer is suspected, in addition to excision of a piece of tissue, the mucous membrane of the cervical canal is scraped.

Aspiration biopsy can be used to obtain material from the uterine cavity. For this purpose, a special Brown syringe is used, equipped with a long tip with a smooth rounded end. In addition to the Brown syringe, glass slides are required, onto which the aspirate is applied, air dried, and transported to the laboratory.

Abdominal puncture. Puncture of the abdominal cavity is performed through the posterior vaginal fornix and the anterior abdominal wall. A puncture is performed through the posterior fornix if a tubal pregnancy is suspected, sometimes in acute inflammatory processes of the uterine appendages and pelvic peritoneum in order to detect blood, serous or purulent effusion in the abdominal cavity.

Puncture through the anterior abdominal wall is performed in the presence of ascites. Ascitic fluid is examined for the content of atypical cells to exclude malignant tumor. The absence of atypical cells in ascitic fluid may indicate a connection between ascites and some kind of heart disease, cirrhosis of the liver.

A set of necessary instruments for puncture through the posterior vaginal fornix: spoon-shaped mirrors, forceps (2), bullet forceps, syringe with a long needle (12-15 cm) with side holes. Sterile material, alcohol, and tincture of iodine are also needed.

Preparing the patient, as for diagnostic curettage. Asepsis is mandatory. In case of tubal pregnancy receive dark blood with small clots. When receiving a serous or purulent effusion, it is necessary to carry out a bacteriological examination (the punctate for culture is collected in a sterile tube with a stopper).

After the operation, the patient is transported to the ward on a gurney.

End of work -

This topic belongs to the section:

Gynecology. Complaints: leucorrhoea, pain, bleeding, dysfunction of adjacent organs, sexual dysfunction, itching of the external genitalia

Any gynecological pathology has very similar symptoms, so no matter what pathology a woman comes with, her complaints are... complaints of leucorrhoea, pain, bleeding, dysfunction of adjacent organs.. there are many other complaints, but these complaints are the main ones..

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