PNEUMOPERITONEUM (pneumoperitoneum; Greek pneuma air + lat. peritoneum, from grech, peritonaion a peritoneum) — filling with gas of an abdominal cavity. Arises owing to patol, the process or damage leading to perforation of a wall of a stomach or intestines (perforated P.) and also it is imposed artificially with diagnostic (diagnostic P.) or medical (medical P.) the purpose.
Perforated pneumoperitoneum most often is a consequence of a perforation of a wall of a stomach or a gut (perforation of an ulcer, ulcerated tumor, an injury of a stomach, etc.) and it is found radiological in the form of a light strip of gas under a dome of a diaphragm in vertical position of the patient or between an abdominal wall and belly bodies in lateroposition (see. Polyposition research ).
Diagnostic pneumoperitoneum (a synonym a pnevmoperitoneografiya) — rentgenol. a research of abdominal organs after administration of gas in it. It is developed in 1913. In weber (E. Weber) in experimental conditions is also for the first time applied in a wedge, the practician Loreem (And. Lorey). In development of this method active part was taken by M. I. Nemenov, G. S. Rukhimovich, L. D. Lindenbraten, Getz (O. of Goetze), F. Partsch, J. Stein, etc.
resort To diagnostic P. when others rentgenol, methods were insufficiently effective and for specification of the diagnosis it is required to estimate a surface condition of abdominal organs and their relationship. Due to the development of modern methods of a research — endoscopies (see), gamma stsintigrafii (see. Stsintigrafiya ), angiography (see) and a computer tomography (see. Tomography computer ) the need for P. arises seldom. Main indications: differential diagnosis of defeats of a diaphragm and tumors and cysts, adjacent to it, recognition of anomalies of development of a liver and spleen, germination of a tumor of a stomach or large intestine in the next bodies, and also diagnosis of tumors, cysts, malformations of a uterus and appendages.
Serious condition of the patient, acute inflammatory damages of abdominal organs, dekompensirovanny diseases of cardiovascular system, lungs, liver and kidneys. Carry the postponed myocardial infarction, stenocardia, a ciliary arrhythmia and a Bouveret's disease to number of relative contraindications.
Diagnostic P. is imposed on an empty stomach after purgation and bladder emptying. In nek-ry cases, napr, to children, carry out premedication (see. Anaesthesia ). The patient is stacked on a back, the average department of a stomach is bared, and other departments of a body close sterile sheets. As a rule, the puncture is made in the point located on 3 — 4 cm to the left and from top to bottom from a navel. After processing of a surgery field carry out local anesthesia of 0,5% by solution of novocaine. Puncture with a needle 6 — 10 cm long with mandrin an abdominal wall, and then advance a needle on 0,2 — 0,3 cm and clean it mandrin. Back motion of the piston of the syringe check whether blood appears in the syringe, i.e. whether the end of a needle got into a blood vessel. The needle is attached to the device for imposing of pheumothorax. After introduction of 25 — 30 cm 3 gas (nitrous oxide or carbon dioxide gas) find fluctuations of a gage hand: on a breath pressure becomes positive, and on an exhalation — negative. Lack of such fluctuations of pressure is observed at extensive unions in an abdominal cavity, and bystry and sharp build-up of pressure — at an accidental puncture of a wall of a gut. Gas is usually entered with a speed of 100 — 200 cm 3 in 1 min. For a research of a diaphragm and an upper pole of a stomach it is enough to adult to enter 800 — 1000 cm 3 gas, for studying of a liver, a spleen, a gall bladder, kidneys and a peritoneum — 1200 — 1600 and bodies of a small pelvis — 700 — 900 см^. To children aged from 3,5 months up to 2 years enter from 40 to 200 at more advanced age — from 250 to 700 cm 3 gas. At release of blood from a needle, emergence of severe pains in a stomach, and also a sharp aggravation of symptoms of the patient administration of gas is immediately stopped. After administration of gas is finished, the needle is taken. To the place of a puncture impose a sterile sticker.
After P.'s imposing make Polyposition rentgenol, a research. Standard positions which in most cases provide the best rentgenol are offered. display of abdominal organs. Sometimes P. combine with tomography (see) and inflating of a stomach or intestines (see. Pariyetografiya ). Normal gas evenly fills overlying departments of an abdominal cavity (fig. 1). On its background the image of a peritoneal surface of a diaphragm, a liver, spleen, an upper pole of a stomach, intestinal loops, a uterus and its appendages, and also the surfaces of kidneys accurately appears. Change of situation, size, a form, contours and relationship of these bodies, and also emergence of a shadow patol, educations allow to judge localization, prevalence and character patol, process (fig. 2).
At observance of the technique of a research P. is safe intervention. Reactions of the patient do not go beyond physiological and are noted only within several hours. The patient has feeling of a raspiraniye in a stomach and pain in shoulder girdles, especially right. Sometimes there are dizziness, nausea and even vomiting. In the evening in day of a research temperature increase to subfebrile figures can be observed. At development of a hematoma of an abdominal wall there is enough imposing of a compressing bandage. Hypodermic emphysema of an abdominal wall does not demand treatment.
Medical pneumoperitoneum — administration of air in an abdominal cavity with the medical purpose. The air entered into an abdominal cavity causes irritation of receptors of a peritoneum, the last is transferred reflex to the neuromuscular device of a lung, causing fall of a pulmonary parenchyma. The changes occurring in these conditions in lungs krovo-and lymphokineses, oxidizing processes positively influence the course of tuberculosis.
Indications and Contraindications
Indications. In the conditions of antibacterial therapy medical P. is shown at the infiltrative and pneumonic, hematogenous disseminated, cavernous pulmonary tuberculosis; at the pulmonary blood spitting which is not stopping under the influence of pharmaceuticals after nek-ry operative measures on lungs.
Contraindications: a cirrhotic pulmonary tuberculosis with the phenomena of a pneumosclerosis and emphysema of lungs; dysfunctions of cardiovascular system, inflammatory processes of abdominal organs and small pelvis, hernia, pregnancy.
Equipment medical P. it is similar to imposing diagnostic P. Kolichestvo of the entered gas hesitates from 500 to 600 intervals between blowings make 5 — 7 days, duration of treatment for 6 months up to 1,5 — 2 years.
Complications can be same, as at the diagnostic Item.
Bibliography: Lindenbraten L. D. An artificial pneumoperitoneum in radiodiagnosis, M., 1963, bibliogr.; Lindenbraten L. D. and Naumov L, B. Methods of X-ray inspection of bodies and systems of the person, Tashkent, 1976; Nemenov M. I. Radiodiagnosis of an echinococcus, Pneumoperitoneum, Vestn, rentgenol, and radio-gramophones., t. 2, No. 1, page 1, 1922; Harcheva K. A. A collapsotherapy in complex treatment of suffering from tuberculosis lungs, L., 1972; Lor e at And. Hydropneumoperitoneum, Verh. dtsch. Rontg. - Ges., Bd 8, S. 46, 1912; Weber E. tiber die Bedeutung der Einfiihrung von Sauerstoff resp. Luft in die Bauchhohle fiir die experimentelle und diagnostiscJie Rontgenologic, Fortschr. Rontgenstr., Bd 20, S. 453, 1913.
L. D. Lindenbraten; K. Ya. Keleberda (ftiz.).