Pneumotropica

Pneumotropica - gas introduction in the retroperitoneal space for diagnostic purposes. On the eve and the day of the examination the patient put a cleansing enema with the addition of 5 g tannin. The study was conducted on an empty stomach. The patient give a knee-elbow position or on the right side with their legs bent and given to the stomach feet. Shave the hair on the skin around the tailbone. After treatment, the skin around the anus alcohol and iodine spend layered anesthesia tissue between the coccyx and rectum 0.25% solution novokaina. Through a needle introduced to a depth of 5-6 cm between the anus and the coccyx, enter 1000-1500 ml gas (oxygen, nitrous oxide, carbon dioxide), which within 30 minutes is distributed under the retroperitoneal space. Then do the x-rays, on which it is possible to see the outlines of the kidneys, adrenal glands, spleen, lumbar muscles, sometimes uterus and appendages, and pathological processes in these bodies (tumors, infiltrates, bridges and so on). Often pneumotropica combined with intravenous urography (see) and retrograde by pielografia (see).

Pneumotropica (from the Greek. pneuma - air, lat. retro is back and Greek. peritonaion - peritoneum) - introduction to retroperitoneal space gas (oxygen, carbon dioxide, nitrous oxide) with x-ray diagnostic purpose. Often use oxygen. Pneumotropica is a valuable and relatively easy way to study, proposed in 1948 Rivas (M. Century Rivas). The pneumotropica has obvious advantages over earlier pneumoina (gas introduction in okolopochechnuyu fibre) by enabling the study of retroperitoneal organs from both sides and risk reduction gas embolism, as insufflation gas produced in poorer vessels region.
Pneumotropica shown in diseases that require a clear understanding of the position, shape, size, outer contours of the retroperitoneum and some abdominal organs (for example, spleen). Contraindications: severe General condition of the patient, purulent inflammatory processes pararectal cellular tissue, varicose veins of the pelvis and rectum.
The technique. On the eve and the day of the examination the patient put enema with the addition of 5 g tannin; the hair on the skin around the tailbone shave, the patient takes hygienic bath. The study produced on an empty stomach. The patient give a knee-elbow position or on the right side with their legs bent at the knee and hip joints and stomach feet. After pre-treatment of the skin around the anus alcohol and iodine under the control of the index finger entered in a direct gut, produce layered anesthesia tissue between the coccyx and rectum 0.25% solution novokaina. Then Tolstoy long needle dotted line in the skin, subcutaneous tissue and anal PC bundle of 0.5-1 cm away from the body and above the tops of the coccyx. Needle promote 4-6 cm deep parallel to the coccyx under the control inserted into the rectum index finger or monitor the progress and final position of the needle (Fig. 1). In retrolectro space easily, without power pressure on the piston of the syringe, inject 80-100 ml of 0.25%solution novokaina. Shortness of introduction of novocaine shows that the needle tip depends on the tailbone or sacrum; slight displacement of the needle in the direction of the rectum fixes its position. Insufflation gas (1000-1500 ml) carry out slowly (5-7 minutes) under low pressure with the help of the apparatus for the imposition of a pneumothorax or of Bobrov's apparatus. X-ray examination is carried out in 30-60 min after the introduction of gas. If the image bodies fuzzy, x-rays should be repeated after 2-3 hours, and sometimes even a day later.
In the absence of adhesions after inflammatory diseases, postoperative cicatrices, germination of primary and metastatic tumors in surrounding tissue pneumotropica provides obtaining the x-ray clear image contours of the kidneys, adrenal glands, pancreas, retroperitoneal tumors, facilitate the differential diagnosis of retroperitoneal and intraperitoneal tumors, clarifies the relationship of pathological formations with other bodies.
Pneumotropica especially valuable for tumors of the kidney, adrenal, kidney cysts (Fig. 2, 3, 4). P. facilitates the identification of anomalies of the kidneys. P. used in combination with retrograde pielografia and excretory urography (see Kidney, x-ray diagnostics), aortography (see) and penacabarga. Diagnostic possibilities P. rise significantly in combination with computed tomography (see), especially in the recognition of diseases of the adrenal glands.
Complications are rare. It is completely passing subcutaneous emphysema crotch and scrotum, puncture rectum. When wounded vessels possible gas embolism. Side effects (mediastinal emphysema and neck, causing a feeling of bloating and dull pain in the chest and abdomen and lumbar region) are in process of resorption of gas.

Fig. 1. Introduction of a needle into retrolectro space.
Fig. 2. Swelling of the lower half of his left kidney. Well seen contours of the kidneys and spleen.
Fig. 3. Pneumotropica and bilateral retrograde pyelography. The contours of the left kidney is not changed. The right kidney considerably enlarged, filling defect middle and upper cups (a tumor of the right kidney).
Fig. 4. Pneumotropica. On the left is rounded shadow of the adrenal gland, increased by tumor (pheochromocytoma).