LAPAROCENTESIS

From Big Medical Encyclopedia

LAPAROCENTESIS (Greek lapara groin, stomach + kentesis piercing; synonym: abdominal paracentesis, abdominal puncture, «needle» paracentesis, paracentesis abdominis) — a puncture of a front abdominal wall for receiving from an abdominal cavity of pathological contents at diseases or injuries of abdominal organs. The term «laparocentesis» was strengthened in surgical literature from 60th 20 century.

In 1880 it is mute. the surgeon I. Mikulich made a paracentesis abdominis a trocar and received gas with a smell of alcohol that confirmed the diagnosis of a perforated ulcer. It served as the beginning of development of a new diagnostic method. For a puncture used usual syringe needles, spinal needles, needles of a special design, a troakara. The equipment L was comprehensively studied. (place of a puncture, possibility of damage of bodies of a stomach, hl. obr. a small bowel etc.), a ratio with other methods of a research (radiological, endoscopic, radio isotope, etc.). Researches showed that the most reliable results can be achieved during the use of a trocar and catheter. So, Berdzher (W. J. Berger, 1969), having made 100 patients with the closed injury of a stomach a puncture with a needle in the beginning, and then a trocar, received the results confirmed with the subsequent laparotomy, respectively in 78 and 99,4% of cases.

In a wedge, practice the method found the most wide spread occurance at the closed injury of a stomach and acute surgical diseases of abdominal organs.

Indications and Contraindications

Indications: difficult cases in the diagnostic relation of the closed injury of a stomach; some open injuries of a stomach with localization of a wound on its side and back walls; the opened and closed injuries of a breast in the field of a costal and phrenic sine forcing to suspect injuries of abdominal organs; atypically proceeding acute diseases of abdominal organs; not clear postoperative complications testimonial of «accident» in an abdominal cavity; difficult for diagnosis acute ginekol, diseases; pseudo-peritoneal syndrome; ascites at heart diseases and cirrhoses of a liver.

Contraindications: the expressed meteorism, commissural process in an abdominal cavity.

Technique

Diagrammatic representation of a technique of a laparocentesis: and — after a section kozhn the abdominal wall is delayed by a single-toothed hook (1) up; — a puncture of an abdominal wall a trocar (2); in — aspiration of contents from an abdominal cavity through a catheter (3) by means of the syringe (4).

The paracentesis abdominis can be made almost in any point of a front abdominal wall, however it is more preferable in the zone which does not have muscular arrays i.e. on the white line of a stomach. In the USSR the most widespread technique of L. the modification developed by A. N. Berkutov and soavt is. (1969). Position of the patient — lying on spin. On the centerline of a stomach 3 — 5 cm lower than a navel under local anesthesia of 0,5% solution of novocaine makes a section of skin up to 1,5 cm long. In an upper corner of a section a single-toothed hook the aponeurosis on the white line of a stomach is punctured. The hook is transferred to vertical position, the abdominal wall is delayed up. Then rotary motion of the trocar entered into a skin section at an angle 45 — 60 ° to the horizontal plane the abdominal wall to feeling of «failure» is punctured and after extraction of a stylet the transparent catheter for the subsequent aspiration of contents (fig.) is entered into an abdominal cavity. In case of existence in an abdominal cavity of a large amount of blood or other contents it is found at the first aspiration. If in an abdominal cavity there is a small amount patol, contents, then, changing the direction of a casing of a trocar, the catheter is entered clockwise in right and left hypochondrium, by side departments of a stomach, a pelvic cavity with the subsequent aspiration of contents the syringe. Similar reception received the name of a laparocentesis using the «rummaging» catheter. If patol, contents because of trace amount (to 100 ml) do not manage to be aspirated, enter 500 — 800 ml of 0,9% of solution of sodium chloride with the subsequent its aspiration into an abdominal cavity and a lab. research (determination of amount of hemoglobin, erythrocytes, leukocytes, diastases). Upon termination of a research the catheter and a casing of a trocar are taken, and on a wound of an abdominal wall if the urgent laparotomy is not supposed, imposed 1 — 2 silk a seam.

Yu. G. Shaposhnikov, I. S. Shemyakin, M. N. Lizanets (1976) improved this technique: for fixing of an abdominal wall they recommend to stitch an aponeurosis of direct muscles a silk ligature, as a catheter apply a chlorvinyl tube with a large number of openings in the lower third it; in the absence of blood the catheter is left sometimes in an abdominal cavity to 2 days for dynamic observation; test of Ruvilua — Grégoire for definition of the termination of intra belly bleeding is put: if the blood received from an abdominal cavity does not turn, it testifies to a stop of bleeding that is an important point for definition further to lay down. (operational) tactics.

In the institutions giving the emergency surgical help for performance of L. usually there is constantly ready for application set of necessary tools.

Complications

Complications: damages of a small bowel or a blood vessel of an abdominal wall are possible (the last can lead to the false conclusion about existence of bleeding).

Assessment of a method

the Method is applicable only in a hospital. According to V. E. Zakurdayev (1976), diagnostic reliability of L. reaches 95 — 98%. Along with a laparoscopy (see. Peritoneoskopiya ) and other tool methods L. allows to reduce considerably time of presurgical inspection of patients, it is correct to plan character to lay down. actions. Simplicity, availability, high diagnostic value do L. by a perspective method for field surgery.


Bibliography: Golden eagles A. N., Tsybulyak G. N. and Zakurdayevv. E. Questions of diagnosis at a stupid injury of a stomach, Vestn, hir., t. 102, No. 2, page 92, 1969; Zakurdayevv. E. Diagnosis and treatment of injuries of a stomach at a multiple injury, L., 1976, bibliogr.; Mikheyev V. I., Sibgatulinn. 3. and Hanzhina. N. Laparotsentez in an urgent surgery of a stomach, Vestn, hir., t. 118, No. 3, page 31, 1977; Sh and p about sh N and - to about in Yu. G., Sh e of m I to and N I. S. and Lizanets M. N. Diagnostic opportunities of a laparocentesis at the closed injury of a stomach, in book: Sovr, probl. soldier. medical, under the editorship of Yu. S. Kravkova, etc., page 196, M., 1977; Berger W. J. Evaluation of «Intercath» method of abdominal paracentesis, Amer. Surg., v. 35, p. 23, 1969; M i-k u 1 i with z J. Weitere Erfahrungen tiber die operative Behandlung der Perforations-peritonitis, Langenbecks Arch. klin. Chir., Bd 39, S. 756, 1889; T h a 1 E. R. a. Shires G. T. Peritoneal lavage in blunt abdominal trauma, Amer. J. Surg., v. 125, p. 64, 1973.


M. A. Korendyasev, M. H. Lizanets.

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