How to do pneumoperitoneumography

Pneumoperitoneum, also known as artificial pneumoperitoneum, must be established before laparoscopic surgery to separate the peritoneum from the internal organs and expand the abdominal cavity. Establishing artificial pneumoperitoneum is the key to laparoscopic surgery. Pneumoperitoneumography is another use of artificial pneumoperitoneum, which is used to diagnose abdominal effects and is of great significance in diagnosing gastrointestinal diseases. With the development of minimally invasive technology, pneumoperitoneumography technology has gradually matured. So, let’s take a look at how to perform pneumoperitoneumography.

principle

Pneumoperitoneum can be divided into pathological pneumoperitoneum and artificial pneumoperitoneum. The former may be caused by abdominal wall damage, allowing gas to enter the abdominal cavity from outside the body. More commonly, it is gastrointestinal perforation, allowing gas to enter the abdominal cavity from the digestive tract. Rarely, it is caused by severe gas-producing bacteria infection in the abdominal cavity. Rare air cyst disease can also cause pneumoperitoneum. Generally speaking, the amount of pneumoperitoneum is very small and has little effect on the body. In medicine, it is mainly used as a clue for diagnosing diseases. Artificial pneumoperitoneum is created by injecting gas into the abdominal cavity for the purpose of clinical diagnosis and treatment. When tuberculosis was rampant in the last century, artificial pneumoperitoneum technology was widely used around the world to treat stubborn tuberculosis cavities. This technique was to inflate the abdominal cavity, compress the lungs by raising the diaphragm, and promote the collapse and healing of the cavity. Artificial pneumoperitoneum is also an important part of laparoscopic technology. Insufflation of the abdominal cavity separates the anterior and posterior abdominal walls, creating an operating space for diagnosis and treatment, which is a prerequisite for subsequent work. With the widespread development of minimally invasive surgery, people have conducted quite in-depth research on the pathophysiological process of pneumoperitoneum. Normally, the working pneumoperitoneum pressure of laparoscopy is 12~15 mmHg. However, this pneumoperitoneum is performed under general anesthesia to meet the requirements of the operation and reach the ultimate application within the safety range. Another use of artificial pneumoperitoneum is as a contrast medium for abdominal radiographic diagnosis. Since artificial pneumoperitoneum has a certain risk of trauma, conventional X-ray images overlap front and back and have a very small scope of application. With the development of modern medical imaging technologies such as ultrasound, CT, and magnetic resonance imaging, invasive examinations such as pneumoperitoneumography have been basically abandoned in clinical practice and have faded out of people's view.

value

CT, especially spiral CT, has powerful three-dimensional imaging and image post-processing capabilities, bringing new vitality to the application of pneumoperitoneumography. Pneumoperitoneum can provide good abdominal image contrast and significantly improve the sensitivity and accuracy of diagnosing various lesions on the inner surface of the abdominal wall compared with conventional CT. The diagnostic application of postoperative abdominal wall intestinal adhesions is a typical example. It can be expected that pneumoperitoneotomy can also demonstrate the unique value of using old methods in new ways in the diagnosis of diseases such as intra-abdominal tumor implantation and metastasis, difficult abdominal wall hernia, abdominal cocooning, omentum adhesion syndrome, and congenital lesions of the umbilicus.

The artificial pneumoperitoneum of pneumoperitoneumography is the pneumoperitoneum that can be tolerated under physiological conditions. The maximum intra-abdominal pressure we measured is 7~8mmHg. It is normal for patients to experience abdominal distension and pain and mild feeling of shortness of breath. After the CT scan is completed, the abdomen will release gas and collapse. The hypertonic time is short and has little impact on the patient's cardiopulmonary function. The discomfort disappears immediately after the pneumoperitoneum is released, and the body recovers to its original state. Patients with more residual gas may have short-term shoulder and back pain, which is related to the fact that the diaphragm has been stretched and stimulated and has not yet recovered. When the patient changes his body position, he will feel a strange sensation of internal organs moving. These will disappear quickly as the abdominal gas is absorbed.

Precautions

The risk of pneumoperitoneumography is puncture of intra-abdominal organs, which may cause damage to the intestines, blood vessels, or solid organs such as the kidneys. Too shallow an insufflation will cause gas accumulation in the abdominal wall, while too deep an insufflation will cause gas accumulation in the retroperitoneum. A small amount of gas accumulation has mild symptoms and is not very harmful, but a large amount of retroperitoneal gas accumulation may cause mediastinal emphysema or even pneumothorax. Therefore, the indications for pneumoperitoneography must be strictly controlled and should not be abused. During the operation, medical staff should pay attention to the patient's reaction and monitor the whole process.