My Assistant Professor was performing a laparoscopy. He had just performed a hysteroscopy on that patient. When he put a Veress' needle into the peritoneal cavity to create a pneumoperitoneum and aspirated with a syringe, he got a free flow of fluid.
"Oops!" he said. Perhaps the needle was in the urinary bladder, though the woman should not have had any urine in her bladder, having passed urine before entering the OT. He withdrew the needle and reinserted it. He aspirated fluid again.
"Wait for me" I said. "Don't do anything until I come." I washed up, put on sterile gown and gloves and took over. My efforts at putting the needle into the peritoneal cavity met with similar results.
"I think the tip of the needle is lying in a pool of Ringer's lactate that you used for distending the uterine cavity for hysteroscopy. That fluid must have entered the peritoneal cavity through the fallopian tubes." I proceeded with the laparoscopy. I was right. There was a big pool of fluid in the anterior peritoneal pouch, though it is usually in the pouch of Douglas. The urinary bladder was empty. There was no abnormal finding. The tubes were patent, as confirmed by chromopertubation.
"False scare!" I declared.
One month later I was assisting my Registrar perform a htysteroscopy-laparoscopy on another patient. The month old history repeated.
"I think it is the hysteroscopy fluid collected in the pelvis that you have aspirated" I said. "Anesthetist, please auscultate her while we insufflate carbon dioxide through the needle. See if there are bubbling sounds."
He auscultated and declared there were bubbling sounds.
"That is the gas escaping into the pool of fluid" I said. I wonder if gas is insufflated into a partially full urinary bladder, similar bubbling sounds will be heard.
"Oops!" he said. Perhaps the needle was in the urinary bladder, though the woman should not have had any urine in her bladder, having passed urine before entering the OT. He withdrew the needle and reinserted it. He aspirated fluid again.
"Wait for me" I said. "Don't do anything until I come." I washed up, put on sterile gown and gloves and took over. My efforts at putting the needle into the peritoneal cavity met with similar results.
"I think the tip of the needle is lying in a pool of Ringer's lactate that you used for distending the uterine cavity for hysteroscopy. That fluid must have entered the peritoneal cavity through the fallopian tubes." I proceeded with the laparoscopy. I was right. There was a big pool of fluid in the anterior peritoneal pouch, though it is usually in the pouch of Douglas. The urinary bladder was empty. There was no abnormal finding. The tubes were patent, as confirmed by chromopertubation.
"False scare!" I declared.
One month later I was assisting my Registrar perform a htysteroscopy-laparoscopy on another patient. The month old history repeated.
"I think it is the hysteroscopy fluid collected in the pelvis that you have aspirated" I said. "Anesthetist, please auscultate her while we insufflate carbon dioxide through the needle. See if there are bubbling sounds."
He auscultated and declared there were bubbling sounds.
"That is the gas escaping into the pool of fluid" I said. I wonder if gas is insufflated into a partially full urinary bladder, similar bubbling sounds will be heard.
