LESSON 2: Procedures in Gynecological and Obstetrical Surgery

Section Ii: vaginal surgery

2-31

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2-31. COLPOTOMY

a. General. Needle culdocentesis is the insertion of an aspirating needle through the posterior fornix of the vagina. Posterior colpotomy is an incision through the vagina and peritoneum and the removal of pus and blood. The needle procedure is done to diagnose ectopic pregnancy or to detect intraperitoneal bleeding or cul-de-sac hematoma. Posterior colpotomy is done to evacuate pus and establish drainage from a cul-de-sac abscess or tubo-ovarian abscess, or in a search for blood when a tubal pregnancy is suspected.

b. Operative Procedure.

(1) For needle culdocentesis, a 15-gauge needle attached to a syringe is inserted through the posterior fornix of the vagina. Suspected intraperitoneal bleeding is confirmed if dark or red blood flows freely into the syringe. Failure to obtain blood does not rule out the possibility of pregnancy completely.

 

(2) For posterior colpotomy, a transverse incision using angular blade scissors is made through the vagina and peritoneum behind the cervix at the superior point of the posterior fornix. The cul-de- sac is punctured with a long Rochester-Pean hemostat. The jaws of the hemostat are spread apart to enlarge the opening and permit the flow of liquid from the cul-de-sac. The cavity is explored; drains may be inserted.

 

(3) In either procedure, bleeding of the vaginal wall is controlled by sutures of chromic gut number 2-0; dressings are applied to the wound surface and held in place with a binder.

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