PNEUMORETROPERITONEUM

Abstract

It is a difficult task to get a sharp picture of the parenchymatic organs such as kidney, ureter, bladder, prostatic gland etc. which are situated in the retroperitoneal cavity on the film. For the purpose, “Pneumoren” has been generally utilized in the past, but the practice with this material requires utmost care and skilled technique, and sometime, it causes danger. In 1947, R. Rivas succeeded to take pictures of kidney, liver, spleen, uterus, organs in the mediastinum or thyloid gland by shifting the gas, which was injected through the caudal canal, to the retroperitoneal cavity, periuterine connective tissue or to the mediastinum by setting an adequate posture. Since then, this method has been widely employed for the purpose.
The author's method is as follows :
The patient is set in a knee-elbow posture, and a pillow is placed at the popliteal region to support the loin from sinking downwards. Infiltration anaesthesia is given immediately above or approximately 1 cm below the apex of the sacral bone with 1-2 procain hydrochloride solution. A puncture needle of approximately 4 cm long is inserted through this region into the apex of the sacral bone and is led into the caudal canal leading it with the index finger or middle finger inserted into the colon in order to protect the colon from injury. After the absence of back-flowing of blood was confirmed, 1, 000-1, 500 cc of oxygen gas is injected through the needle. The patient is then given a rest for approximately 2 hours with the upper part of the body kept upright or keeping the side, in which the organ to be filmed, up before the picture is taken. No specifically dangerous side reactions are recognized.
The advantages of this method are as follows :
(1) It requires no specific skills. It can be practised even by a beginner without difficulties.
(2) Roentgenography of both kidnies can be performed after one injection of oxygen gas. Consequently, the hardships and the burdens on the part of the patient are lighter.
(3) In this method, there are no fear of injuries of blood vessels. Consequently, there are no dangers of embolism.
(4) In this method, there are no dangers of injuries of kindney Therefore, this method is applicable to even a swollen kidney, to which ordinary pneumoren method can not be applied.
(5) This method can be applied even in the case where there are perirenal inflammations.
(6) The roentgenographs of liver, spleen, pancreas etc. can be taken with this method.
(7) The shape of the bladder, presence or absence of infiltration in the bladder wall, the location and size of the tumour etc. can be clearly observed by this method combined with pneumocystography in gathering the gas in the pelvic cavity around the bladder.
(8) Not only in the field of urology, this method can be advantageously utilized also in the field of gynecology, surgery or internal medicine.