Culdocentesis

Excerpt

Culdocentesis was, at one point, a mainstay for evaluation and diagnosis of hemoperitoneum that has largely been replaced by the increasing availability of high-resolution transvaginal sonography. Culdocentesis is still widely used in developing countries that may not have access to sonography, such as Papua New Guinea, where it is the most common aid for the diagnosis of ruptured ectopic pregnancy.

It is especially important for diagnosis in countries with high rates of anemia and pelvic inflammatory disease as these can mimic ruptured ectopic pregnancy. Culdocentesis has been important in the diagnosis of ruptured ectopic pregnancy, especially in the days before sonography. Ruptured ectopic pregnancy is considered to be a surgical emergency, and prompt diagnosis is critical.

Culdocentesis can also aid in the diagnosis of other conditions. For example, acute salpingitis or pelvic inflammatory disease will have purulent peritoneal fluid. Endometrioma will have "chocolate" fluid, and ascitic fluid return can be seen in other conditions. Hemoperitoneum can be present in multiple pathologies and can cause false-positive results such as hemorrhagic ovarian cyst, torsion of an ovarian cyst, and ruptured ovarian follicle.

A negative culdocentesis (clear or serosanguinous fluid return) does not exclude ectopic pregnancy, and repeat culdocentesis at a later time may be needed. A negative culdocentesis supports that there is likely no hemoperitoneum and the fallopian tube is intact, but an ectopic pregnancy may still exist that has not yet ruptured. Almost 25% to 30% of ectopic pregnancies result in hemoperitoneum and is a significant cause of morbidity and mortality of reproductive-aged women.