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Dr. Andrew Rynne

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

Mar 2014
User rating for this question
Very Good
Answered by
Practicing since : 2001
Answered : 1390 Questions
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.
Sat, 30 Aug 2014 in Women's Health
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
Follow-up: Suggest treatment for fluid in cul-de-sac with bloating and gas 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
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