Pneumoperitoneum

Pneumoperitoneum (synonym aeropelican) - introduction of gas (oxygen, carbon dioxide) into the abdominal cavity. Introduction atmospheric air is undesirable.
With the medical purpose pneumoperitoneum used in the intestinal tuberculosis and tuberculous peritonitis. Currently pneumoperitoneum is one of the methods of colapsoterapiei (see) at a tuberculosis of lungs.
Pneumoperitoneum applied in the diagnostics of some diseases of the spleen, liver, diaphragm, kardioezofagealnym region, the interior of the reproductive organs in women, with peritoneoscopy (see).

pneumoperitoneum
The position of the patient when imposing pneumoperitoneum.

Pneumoperitoneum impose on an empty stomach after emptying the bladder and cleansing the gastrointestinal tract. A puncture of the abdominal wall is made in the patient lying on his back with enclosed roller (Fig). The puncture site: often left lower quadrant of the abdomen on the edge of a straight muscles. The gas is introduced a device for the imposition of artificial pneumothorax. The quantity of injected gas depends on the evidence and ranges from 300 to 2000 ml (see artificial Pneumothorax).
Complications pneumoperitoneum: subcutaneous emphysema, bleeding in the wall of the stomach and abdomen, injury to the bowel, bladder, gas embolism and other

Pneumoperitoneum (pneumoperitoneum; from the Greek. pneuma - air and peritonaion - peritoneum) - accumulation of gas in the free abdominal cavity. Pneumoperitoneum occurs when a violation of the integrity of the stomach or intestines, or due to perforation of ulcers, and by traumatic pneumothorax in the case of simultaneous damage the diaphragm (with thoracoabdominal injuries). Clinically, these forms of pneumoperitoneum recognized by the appearance of zones of campanita in the navel (the patient lying on the back) and the disappearance of the stupidity of the liver (at the sitting of the patient).
Pneumoperitoneum create artificially by the injection of oxygen in the peritoneal cavity. Medical P. is one of colapsoterapiei (see) at a tuberculosis of lungs.
Diagnostic P. apply to contrast abdominal x-ray examination. P. lay the patient on an empty stomach with empty the bladder and cleaned enema intestine. Patient is placed on his back with a little twist on the right side; the head end of the table is slightly lowered. On the left, 2-3 cm from the front top iliac spine, along the line connecting it with the navel, inject into the thickness of the skin 1-2 ml of 0.5% solution novokaina and at the injection dotted line in the abdominal wall thin (up to 1 mm) trocar side hole at the end. It is necessary to approximately determine the thickness of the abdominal wall and, accordingly, to calculate the depth of wkola to avoid injuries abdominal organs. After extracting stiletto tube trocar slightly promote in depth. If it goes smoothly, and entered into the syringe warm saline solution flows easily and do not spring back, then trocar free abdominal cavity and you can start blowing gas. Apparatus for the imposition of artificial pneumothorax (Fig. 1) blown into the adult 800-2000 ml of oxygen and child 8-10 years of not more than 500 ml With proper technique puncture complications are extremely rare. The wound of the abdomen is threatening internal bleeding, peritonitis, air embolism. The first sign of damage can be the allocation of trocar blood or intestinal gas.
X-ray picture. Gas accumulation in the abdominal cavity easily find the radiological examination, as the gas poorly absorbs x-rays. With a change of position of a body of the patient gas moves into the abdominal cavity, always being the most highly located departments ("Zenit"). At vertical position gas is collected mainly under the dome of the diaphragm, while standing on the left side is in the right colon channel between the abdominal wall and liver, etc.
X-ray examination is widely used in the clinic when pneumoperitoneum, caused by infringement of an integrity of hollow organs of the abdominal cavity, and artificial., In the first case, the x-ray detection P. proof punching walls of the hollow body. When medical P. radiologist determines the number and distribution of gas in the abdominal cavity and the position of the diaphragm.
For diagnostic purposes pneumoperitoneum used in the cases, when simpler methods of investigation insufficient to clarify the diagnosis or clarification is needed as to morphological features of organ damage. The highest value P. acquired in recognition of diseases of the diaphragm, chronic liver and spleen, tumors of the code and of the gastric cardia, diseases of the small pelvis women.
Contraindications: severe the patient's condition, acute inflammatory lesions of organs of abdominal cavity, decompensation of cardiovascular system and kidneys.
X-ray examination at P. produced in different projections and at various positions of the body of the patient (Fig. 2)in order to achieve the transfer of gas in the abdominal cavity and optimal display on the film of the studied organs. Widely combine P. with imaging and contrast study of the stomach, colon, kidney, bladder, uterus.
On radiographs with pneumoperitoneum emerging all the departments of the diaphragm. You can recognize its segmental hypoplasia and hernia and to distinguish them from the hydatid cyst or tumor of the liver and spleen. On the background gas well visible all the departments of the liver (possible to judge their size, plasticity), which enables to reveal cirrhosis, cysts or tumors of the liver (Fig. 3). Easily recognized by splenomegaly and cysts of the spleen.
The introduction of gas into the abdominal cavity with simultaneous inflating gas stomach or intestine is a valuable way to detect small tumors of the digestive tract (see Paleography). In addition, you can define a transition tumors of the stomach to adjacent organs.
Great value Ii. has in determining the location, size and surface of the uterus, fallopian tubes and ovaries (gas paliography). It gives the opportunity to detect abnormalities of internal genital organs of women, ovarian cysts, tuberculosis appendages. Some authors used P. for more accurate diagnostics of cervical cancer (determine its stage) and monitoring the effectiveness of radiation therapy.

Fig. 2. The main items for research in conditions of pneumoperitoneum: 1 - the front surface of the liver, peritoneum, omentum; 2 - the right lobe of the liver; 3 - spleen, descending and sigmoid intestine; 4 - liver (especially of the left lobe), spleen, stomach, intestines; 5 - liver, spleen, kidneys; 6 - the front surface of the liver; 7 - diaphragm, liver, spleen, proximal stomach; 8 - aperture, the proximal stomach, liver; 9 - internal genital organs of the female.
Fig. 3. Liver disease: 1 - syphilis (liver is enlarged, deformed, sealed, brazed with parietal peritoneum); 2 - cirrhosis (liver reduced, sealed, its surface is uneven); 3 - Echinococcus (in the right lobe - partially calcified cyst; liver in this area is sealed with, and linked spikes with aperture).