Pneumoperitoneum and retropropulsion

X-ray examination using artificial contrast agents applicable for hollow organs, connected with the external environment, or such that can be filled using resorbed contrast agents, such as the gall bladder or urinary tract. As for parenchymatous organs, then with the usual contrast study or swelling of intestines about them can be judged only by the changes they cause on the part of the various divisions of the gastrointestinal tract. Enlarged liver or spleen, for example, being located close to the stomach, can change the shape or position of the latter and to find their own paths.
More accurate data about the state of parenchymatous organs and painful processes in the peritoneal cavity, are achieved through the pneumoperitoneum. This method is that puncture is made in the abdominal wall and into the peritoneal cavity is entered up to 2 liters of gas, best carbon dioxide, as it is absorbed faster in air or oxygen. For the introduction of gas into the peritoneal cavity is proposed special machines, but can be successfully use the apparatus for the imposition of a pneumothorax. Due to the presence of gas in the cavity peritoneal create such conditions contrast, as in the chest, i.e. on the background gas clearly differentiate the soft tissue (Fig. 129).

Fig. 129. Pneumoperitoneum. Radiograph.

Moving studied in different positions after the imposition of pneumoperitoneum able to explore and then one or other bodies and to establish whether there is in them grupamocarta changes. When researching in the provisions of sitting or lying down, you can see the bottom surface of the aperture and the top surface of the liver. This clearly are changing the aperture, echinocacti liver, changes in other organs of the abdominal cavity. When prosvechivaniya in other provisions can be distinguished spleen. On the background gas and determined phenomenon wrinkling of the liver, cancer sites and especially peritoneal adhesions. Latest features in different bands. Pneumoperitoneum is very important for differential diagnosis between hernia and relaxation of the diaphragm. Great value pneumoperitoneum to determine increases lymphatic nodes and various extravehicular tumors. Pneumoperitoneum can find wide application in cases where the diagnostic capabilities of other methods have been exhausted, and trial laparotomy for one reason or another not indicated or contraindicated.

Fig. 130. Retropropulsion, combined with pielografia. Retroperitoneal tumor.

Retropropulsion represents method contrasting gas pozitivnogo space (Fig. 130). The imposition of retropreparation is performed by puncturing produced in predmatchevoy region. After careful preparation, consisting in cleaning the bowel, the patient is made, the operation of the introduction of gas in the retroperitoneal space. To do this, the patient is installed in the knee-elbow position, and put the needle on 4-5 cm strictly on the middle line the inner surface of the coccyx. Before the introduction of the gas produced anesthesia 0.25% solution novokaina in the amount of 60-80 ml, then injected the necessary amount of gas, depending on the purpose of retropreparation. For investigation of abdominal and retroperitoneal organs enough to use 750 ml of gas. Where relevant production mediastinoscopy amount of gas is increased to 2 liters. Retropropulsion in combination with imaging gives the best results, especially in the study of the pancreas.
The scope of retropreparation wide enough. In relation to diseases of the gastrointestinal tract, retropropulsion is effective for diseases
the liver, spleen, pancreas, various retroperitoneal tumors. Also very important is the fact that in this study well kontroliruyut kidneys and adrenal glands. Through the holes and triangular slit diaphragm gas from retroperitoneal space penetrates into the chest cavity, which creates opportunities pneumomediastinum. Pneumomediastinum carried out with the help of retropreparation, has been effective in detecting cancer of the esophagus, germination it into neighboring organs, to establish the presence of metastases in the mediastinum, etc., In certain circumstances, retropropulsion can be combined with conventional contrast study of the gastrointestinal tract. Such combined studies in appropriate cases may contribute to the clarification of the diagnosis, especially when using tomography that is necessary for recognition of diseases of the pancreas and esophagus. Thus, retropropulsion greatly enriches the possibilities of modern x-ray diagnostics of diseases of the gastrointestinal tract.