Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

172 Doctors Online
Doctor Image
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Suggest treatment for fluid in cul-de-sac with bloating and gas

Answered by
Dr. Madhuri N Bagde


Practicing since :2001

Answered : 1390 Questions

Posted on Sat, 30 Aug 2014 in Women's Health
Question: I was told that I have an amount of free fluid in my cul-de-sac that is above normal. I had a hysterectomy (removed ovaries, uterus, fallopian tubes and cervix) about 3 years ago. I am 41, 5'7" and 135 pounds.

I have had a lot of gas and bloating lately, as well.
Answered by Dr. Madhuri N Bagde 25 minutes later
Brief Answer:
Numerous causes for such a finding

Detailed Answer:
Hello and welcome to HCM,

I understand that you had a hysterectomy 3 years ago and now have more than normal free fluid in the cul de sac.

It would be immensely helpful if I would know the reason for the hysterectomy.

The cul de sac is the most dependant part of the peritoneal cavity. So any fluid in the abdomen can come and lie in the sac. Even though the common reasons for fluid here are causes in the uterus and pelvic organs, but it may not always necessarily originate from the pelvis. As of now, the common causes of free fluid in the sac after hysterectomy are:
Any lesion leading to accumulation of fluid in abdomen called ascitis. Common causes are liver dysfunction, pancreatic dysfunction, anemia and low serum proteins, peritonitis [ very painful], kidney dysfunction leading to fluid retention everywhere including abdomen. In rare cases cancers can lead to fluid in the cul de sac.

Infections of the abdomen and pelvis like colitis, appendicitis also lead to fluid here.

Presence of gas and bloating indicate a gastrointestinal cause.

So as of now, kindly let me have the details for the need of the hysterectomy.

You will need an examination by a doctor to look for signs of any of the above causes as they are a long list. A few additional investigations like fine needle aspiration of the fluid under ultrasound giudance to examine it as well as an MRI abdomen and pelvis will also help in formulating a diagnosis if localising signs are not found on examination. A blood test called serum proteins and liver as well as kidney function evaluation may be needed.

I suggest that you get these tests done as per your doctors advise after examination as sometimes the cause is obvious like anemia and so only one test is sufficient. So an examination will help in formulating a diagnostic as well as a treatment plan.

Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Madhuri N Bagde 10 minutes later
Thank you for your fast response!

My hysterectomy was a last resort due to pain from endometriosis. I had endo on my bowel at some point (seen through laparoscopy). Can the endo still grow because I am taking compounded hormones? Also, should I see a gynecologist or gastroenterologist for this issue?

Answered by Dr. Madhuri N Bagde 6 minutes later
Brief Answer:
Yes it may grow

Detailed Answer:
Hello and welcome back,

Yes it is possible for it to grow if you are on hormones. As of now, I would suggest it is better to see a surgeon first then he may be able to refer you to someone as per the findings on examination and investigations if any.

Most likely the opinion of a surgeon, gastroenterologist and a gynecologist may need to be combined in your case because as of now there is only fluid and we still do not know the cause.

Hope this helps you.

Please feel free for any more queries.

Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,  
Medical Topics ,   ,  

Recent questions on  Pancreatic dysfunction

doctor1 MD


For the last 18 months I have had the following symptoms near constantly day and night:

- Severe to moderate pressure-type pain in the middle of my chest from my throat to my upper stomach

- Pain and sensitivity to pressure (like when I press on it, lean forward, or when I eat) in my upper stomach

- Nausea

In September 2008 I tested positive via Hida Scan (34.9%) for low gallbladder function. Later that month, my gallbladder was removed, but my symptoms have remained.

In February 2009 I underwent an Endoscopic Ultrasound, which revealed that I was born with a Pancreatic Divisem. Doctors ruled out that this was the cause of the symptoms due to the fact that my amylase and lipase levels are normal.

To date doctors have been able to rule out the following as possible causes:

GERD/Bile Reflux

Esophageal Spasms

Gallbladder Stones/ Dysfunction

Pancreatic Dysfunction

Cardiac Related Problems (Angina, Coronary Spasms, Pereicarditis, etc).

Hiatal Hernia


Celiac Disease

Sphincter of Oddi Dysfunction

Thyroid Condition



Since my symptoms started in May of 2008 I have been to the ER almost 10 times and have had multiple blood draws for (among others) amylase/lipase, sprue panel, thyroid levels as well as CBC rate and hepatitis and a H. Pylori stool sample. I have also had the following tests all which turned up negative:

07-08-08 Gallbladder Ultrasound

07-23-08 Endoscopy

07-28-08 EKG Stress Test/Pulmonary SVC

09-12-08 Barium Swallow

09-17-08 Hida Scan

09-26-08 Gallbladder Surgery

01-09-09 Chest MRI

01-19-09 EGD with MRCP

02-02-09 EGD with Ultrasound

02-06-09 Barium Meal (Gastric Emptying Study)

02-12-09 Small Bowel Follow-Through

02-17-09 EGD with Bravo Placement

06-15-09 Colonoscopy

03-16-10 EGD with Sprue Biopsy

On May 19th 2008 my wife and I took a day trip to Tijuana, Mexico while on vacation in San Diego, CA. Before crossing back over to the US, I stopped ate at taco stand close to the boarder eating two chicken tacos and two pork tacos along with two bottled Cokes. There were no immediate negative effects, but 24 hours later I was having signs of food poisoning in the form of severe cramps, dehydration, nausea and diherria. After a visit to the doctor's office I was given some anti-biotics and felt better generally except for a persistent gnawing at the top of my stomach. Another trip back to the doctor and I was diagnosed with gastritis, tested for H. Pylori and parasites and given a prescription for general Protonix and anti-parasitic medicine. After a few weeks I began to feel better generally and went for a run. This proved to be a mistake because after the run the gnawing sensation returned. I went to the doctor again and this time was checked for gallstones through an ultrasound which came up negative. I was told to continue taking the Protonix and limit my diet to things containing low fat and low acid. That same day I began having severe chest pain, but being only 28 and in good condition assumed that it was nothing serious and after calling the doctor was told that it was most likely acid reflux or esophageal spasms. After a few more weeks of pain and no results from the Protonix I decided to switch to another general practitioner and was able to get in to see a GI specialist. After a barrage of tests ordered by both physicians in late September I had gallbladder surgery. When my symptoms didn't clear up after a few months I was subjected to more testing and tried various drugs to combat smooth and then skeletal muscle tension including nitro glycerin. My GI doctor has ruled out the need for an ERCP, claiming that because my amylase and lipase levels are steady and the risks for the test are too high. The doctor also claimed that I most likely had 'Heightened Viscera Noceception' (which from what I can tell, means absolutely nothing) and that I should get onto an SSRI to correct the problem. This idea was fast-tracked following an emotional breakdown after the death of my brother. I was put on Paxil and Ativan for anxiety and told by my newly prescribed psychiatrist that my pain could be a constant series of anxiety attacks. I was on these medications for eight months and even at maximum dosage both saw no significant improvement. In January 2010 I received the results of a blood draw from a third-party 200 Food Panel testing for IgG. The test indicated that I had an alarmingly high intolerance for wheat, gluten and yeast. To confirm the results I saw a local allergist who performed 50 panel skin prick test. This test came up negative along with subsequent blood-work and a biopsy taken from another EGD. I am currently looking into the viability of IgG food allergy testing and have been on a gluten-free diet for 2-weeks (with no results), with plans to remain on the diet for a least 8 weeks.

What is wrong with me?

doctor1 MD

I'm 28yr F, 157cm, 69 kg I have PCOD and hypothyroidism .. My fasting insulin level is 7.2.. I want to if there any chances of getting diabetes in future since my insulin level is high

doctor1 MD

Please let me know what are the side effects of taking Levipil 500 & Zeptol CR 300 for long time.

doctor1 MD

I am obese , an insulin dependent diabetic female with high blood pressure controlled with medication. I check my sugar levels twice a day and my blood pressure periodically. I have been watching my diet, especially carbs, very closely the past 8...

doctor1 MD

Hi, I'm adicted to steroids for past 4 yrs due to ulcerative colitis . It may lead to diabetis? I m 32, suffering from ulcerative colitis sice 2004, infertility suddenly. having DVT .