From Big Medical Encyclopedia

PNEUMORETROPERITONEUM (grech, pneuma air + lat. retro behind + lat. peritonaeum, from grech, peritonaion a peritoneum; synonym: presakralny emphysema, retropneumoperitoneum) — filling with gas of retroperitoneal space. The item is imposed artificially with the diagnostic purpose (diagnostic P.), extremely seldom gas can get in retroperitoneal space (see) at nek-ry patol, states, napr, at a mephitic gangrene of retroperitoneal or pararenal cellulose, pronikayuoshchem wound of retroperitoneal departments of the duodenum ascending or the descending colon (pathological P.).

Diagnostic The item (presakralny insufflation) — administration of gas in retroperitoneal space for the purpose of contrasting of the bodies located in it at them rentgenol. a research — it was offered in 1947 by Rivas (M. to R. Rivas). Unlike pneumoren (see) P. gives the chance to receive the simultaneous image of all bodies and not organ tumors of retroperitoneal space on roentgenograms. Diagnostic opportunities of the item increase at its combination to excretory urography (see), retrograde piyelografiya (see), tomography (see).

Shortcomings of a method: uneven distribution of gas around bodies and new growths of retroperitoneal space in the presence of unions, and also the shift of kidneys caused by administration of gas distorting them true position and the sizes in pictures. Thanks to implementation in a wedge, practice of infusional urography (see), angiography (see) and especially computer tomography (see. Tomography computer ) P.'s use was considerably reduced.

Fig. 1. Pnevmoretroperitoneumogramma is normal: the adrenal glands (1) and kidneys (2) bordered with a light layer of gas are visible.
Fig. 2. Pnevmoretroperitoneumogramma in combination with excretory urogrammy at a liposarcoma of retroperitoneal space: the left kidney (it is specified by an arrow) is displaced and turned around a longitudinal axis owing to a prelum by a tumor.

Item. use hl. obr. for identification of a form, size of adrenal glands at their tumors and a hyperplasia (pnevmosuprarenografiya), recognitions of tumors and cysts of a pancreas and not organ tumors of retroperitoneal space (fig. 1 and 2), and also at diagnosis of anomalies of development of kidneys (an aplasia, hypoplasias, etc.), a nonfunctioning kidney when it is not possible to carry out a retrograde piyelografiya and an angiography.

Carrying out Item. contraindicated at serious condition of the patient, the expressed cardiovascular insufficiency, acute inflammatory processes in the field of an anus, in a presakralny and retroperitoneal fatty tissue, hemorrhagic diathesis, the expressed atherosclerosis. It is not recommended to carry out P. at a varicosity of a rectum, severe forms of an idiopathic hypertensia.

Item. carry out on an empty stomach, the patient is stacked in genucubital situation or sideways with the legs given to a stomach. After processing of skin of a crotch and local anesthesia (80 — 100 ml of 0,25% of solution of novocaine) a long needle under control of the finger entered into a rectum punktirut a crotch in the point remote on 1 cm of a kpereda from top of a tailbone. The needle is advanced on depth of 6 — 10 cm. If from a needle blood is not emitted, through it by means of the device for artificial pheumothorax or two devices of Bobrov slowly enter 1200 — 2000 cm 3 (on average apprx. 20 cm 3 on 1 kg of weight of the patient) carbon dioxide gas, oxygen or nitrous oxide. After that the patient is stacked alternately on a back, a stomach, the right and left side. In retroperitoneal space monitor distribution of gas by means of usual or X-ray television raying (see. Television in medicine ). The X-ray analysis in a straight line and slanting projections or a tomography is made in 40 — 60 min., and if necessary in 6, 12, 24 or 48 hours after administration of gas.

Administration of gas can cause emphysema of a scrotum, pressure sense in the bottom of a stomach, in a nadchrevya and a mediastinum. Owing to penetration of gas into a mediastinum sometimes there are hypodermic emphysema of a neck, an osiplost of a voice, suffocation, pain during the swallowing. A heavy complication of P. is gas embolism (see), the edge is almost not observed during the use for P.'s carrying out of carbon dioxide gas and nitrous oxide. After carrying out a research establish careful overseeing by the patient timely to find the complications demanding acceptance of urgent measures.

Bibliography: Pytel A. Ya. and Pytel Yu. A. Radiodiagnosis of urological diseases. M, 1966; D e and-t i with to e P. Die Rontgenuntersuchung der Niere und Harnleiters in der urologischen Diagnostik, Munchen, 1965; Handbuch der medizinischen Radiologie, hrsg. v. O. Olsson, Bd 13, T. 1, B. u. a., 1973; Ruiz Rivas M. Nueva tecnica de diagn6stico radiogr^fico aplicaple an organos y estructu-ras retroperitoneales, mediastinicas y cer-vicales, Rev. clin, esp., v. 25, p. 206, 1947.

B. M. Perelman.