Puncture of the posterior vaginal vault - Causes, symptoms and treatment. MF.
This operation is used to confirm the diagnosis of an ectopic pregnancy, rupture of the uterus and other internal organs;to confirm or exclude-the diagnosis of pelvic peritonitis and general peritonitis;to determine the nature of the exudate of saccate tumors of the fallopian tubes and ovaries( only if there is no suspicion of their malignant degeneration).Puncture of the abdominal cavity through the posterior part of the vaginal vault can be performed with therapeutic purpose for suctioning of inflammatory exudate and administration of antibacterial drugs, and also as a preliminary operation before colpotomy( with posterior parametrization) or before colpoceliotomy( with abscess of rectum-uterine cavity).
When starting abdominal puncture through the back of the arch, it should be remembered that this operation is very painful. Before the operation, if possible, it should be emptied of the rectum and necessarily the bladder, the external genitalia and the vagina to treat 70% ethanol alcohol and 1% solution of iodine alcohol. Having exposed the cervix of the uterus, do not grasp it with forceps. It is much more convenient to take the cervix to the pubic symphysis with a lift. In this case, the wall of the back of the vaginal vault is stretched between the lift and the mirror. Before puncturing, the tissues of the back of the vaginal vault must be infiltrated with 1-2% lidocaine solution with a thin injection needle. After waiting 3-5 minutes for Novocain to act, a long injectable needle with a light but sharp push pierces the back of the vaginal vault strictly along the middle line and sucks the syringe that is available in the rectum and uterine cavity. The position of the needle during the puncture should be horizontal or the needle should be pointed slightly upward so as not to pierce the rectum. When ectopic pregnancy is usually sucked defibrinated blood. However, with the internal bleeding that has just begun, blood can be obtained from the abdominal cavity, the fibrin of which has not yet fallen. This blood quickly coagulates, like the blood obtained from the vessel. In some cases, it is not possible to suck anything, although there is blood in the abdominal cavity. This is usually explained by the thrombosis of the needle with a blood clot that can be pushed out of the needle with air using a syringe onto the gauze pad and consider whether it is also possible to push the blood clot out of the needle with a mandril. Getting a blood clot, like defibrinated blood, is enough to confirm the diagnosis of an ectopic pregnancy. Sometimes it is not possible to suck blood because a tissue is sucked into the needle cut and overlaps the lumen of the needle. In such cases, it is necessary to collect a few milliliters of a sterile solution of novocaine or an isotonic solution of sodium chloride in a syringe, insert it into the abdominal cavity and immediately suck. If there is blood in the abdominal cavity, the sucked up liquid will be stained with blood, small fragments of clots will be identified in it.
A therapeutic abdominal puncture is also performed through the back of the vaginal vault. However, if the inflammatory exudate is very dense consistency, an abscess should be injected with a sterile solution, for example, isotonic sodium chloride solution, and suck the dilute exudate now. The exudate is sent to a bacterioscopic and bacteriological study.