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Safer Pneumoperitoneum Refills
Safer
Pneumoperitoneum JOHN
B. DEVINE, St.
Refills M.D.,
Louis,
F.C.C.P.1
Missouri and
EDWARD
DUNNER,
M.D.,
Washington,
D.
F.C.C.P.2
C.
Although much has been written relative to the role of pneumoperitoneum in the treatment of pulmonary tuberculosis, there still remain many unanswered questions pertaining to its therapeutic efficacy, the incidence of abdominal fluid formation, complications, the optimum position of the elevated leaves of the diaphragm, the duration of treatment, etc. Similarly, much has been written relative to the best site for inserting the needle into the abdominal wall or even the lower intercostal spaces. It is believed worth while to mention one aspect of technique which has rarely been presented. As a rule, patients about to receive a pneumoperitoneum refill lie on the back with or without a pillow under the head. Some are tense, some are relaxed, others tend to push the abdominal wall towards the needle. Rarely does the operator pay any attention to the phase of respiration during which the needle is introduced into the abdominal cavity. The illustrations shown graphically portray the differences in the height of the abdominal air space at the end of inspiration as compared with the end of expiration. The patients were advised to “take a deep breath, hold it, push.” The needle was then quickly inserted through the abdominal wall. it is well known that on ‘inspiration the lungs expand, the diaphragm descends, and the contained abdominal air pushes the abdominal wall outward. It will be noted from the illustrations that the increase in height of the abdominal air space at the end of inspiration may reach approximately 40 to 50 per cent. Marmion’ reported a difference dominal air space on deep inspiration We have found that the difference deep inspiration and deep expiration
of
2 cm, between the height of the as compared with normal inspiration. is even greater when the extremes are compared.
While the illustrations depict patients over a period of months, it is suggested of the abdominal air space plays a more nique factor in administering air refills to of pneumoperitoneum induction, and also
who had received air that the difference in the significant role as a safety patients during the early when an unscheduled long
abof
refills height techcourse period
1 Department of Internal Medicine, St. Louis University; Attending Physician, Veterans Administration Regional Office, St. Louis, Missouri. 2 Formerly Area Chief, Tuberculosis, St. Louis Medical Area, Veterans Administration; Department of Internal Medicine, Washington University, St. Louis, Missouri. Presently: Chief, Education & Training, Tuberculosis Service, Veterans Administration, Washington, D. C. 553
554
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PNEUMOPERITONEUM
REFILLS
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of time has elapsed between refills. By the use of this technique of traumatising the underlying visceral contents should be Acknowledgment: Merenda, Radiologist, and cooperation.
The authors wish to express and to Mr. L. F. Erting,
their x-ray
appreciation technician,
for
the danger minimized. to
Dr. their
Samuel assistance
J.
SUMMARY
As shown in the illustrations, the height of the abdominal air space in a patient with artifically induced pneumoperitoneum is increased on deep inspiration as compared with expiration. It is therefore concluded that for those patients receiving pneumoperitoneum refills in whom an appreciable air space is not present, the insertion of the needle at the end of a deep inspiration is a safer procedure to reduce the danger of injuring the abdominal viscera. RESUMEN
Corno se ha mostrado en las ilustraciones Ia altura del aire en el neumoperitoneo artificial, aumenta en Ia inspiraci#{243}n profunda en comparaci#{243}n con la expiraci#{243}n. Se concluye por tanto para los enfermos que reciben neumoperitoneo en los que una capa de aire no es apreciable, la inserci#{243}n de Ia aguja al final de una inspiraci#{243}n profunda es un procedimiento m#{225}s seguro para reducir el peligro de lesionar las vIsceras abdominales. RESUME
Comme ii est montr#{233} sur les planches, l’importance de Ia cavit#{233}a#{233}rique de l’abdomen chez un malade trait#{233} par pneumop#{233}ritoine est infiniment plus #{233}lev#{233}e dans l’inspiration profonde que dans l’expiration. Ii en r#{233}sulte que pour les malades a qui l’on insuffie un pneumop#{233}itoine, lorsqu’il n’y a pas de cavit#{233}gazeuse suffisante, il est plus sflr de faire Ia piqiire a Ia fin d’une inspiration profonde, afin de r#{233}duire le danger be blesser les visc#{232}res abdominaux. REFERENCE 1 Marmion, Tuberk,
T. M.: “Techniques 2:105, 1953.
des
reinsuffiations
du
pneumop#{233}ritoine,”
Schweiz.
Z.
Pneumoperitoneum JOHN
B. DEVINE, St.
Refills M.D.,
Louis,
F.C.C.P.1
Missouri and
EDWARD
DUNNER,
M.D.,
Washington,
D.
F.C.C.P.2
C.
Although much has been written relative to the role of pneumoperitoneum in the treatment of pulmonary tuberculosis, there still remain many unanswered questions pertaining to its therapeutic efficacy, the incidence of abdominal fluid formation, complications, the optimum position of the elevated leaves of the diaphragm, the duration of treatment, etc. Similarly, much has been written relative to the best site for inserting the needle into the abdominal wall or even the lower intercostal spaces. It is believed worth while to mention one aspect of technique which has rarely been presented. As a rule, patients about to receive a pneumoperitoneum refill lie on the back with or without a pillow under the head. Some are tense, some are relaxed, others tend to push the abdominal wall towards the needle. Rarely does the operator pay any attention to the phase of respiration during which the needle is introduced into the abdominal cavity. The illustrations shown graphically portray the differences in the height of the abdominal air space at the end of inspiration as compared with the end of expiration. The patients were advised to “take a deep breath, hold it, push.” The needle was then quickly inserted through the abdominal wall. it is well known that on ‘inspiration the lungs expand, the diaphragm descends, and the contained abdominal air pushes the abdominal wall outward. It will be noted from the illustrations that the increase in height of the abdominal air space at the end of inspiration may reach approximately 40 to 50 per cent. Marmion’ reported a difference dominal air space on deep inspiration We have found that the difference deep inspiration and deep expiration
of
2 cm, between the height of the as compared with normal inspiration. is even greater when the extremes are compared.
While the illustrations depict patients over a period of months, it is suggested of the abdominal air space plays a more nique factor in administering air refills to of pneumoperitoneum induction, and also
who had received air that the difference in the significant role as a safety patients during the early when an unscheduled long
abof
refills height techcourse period
1 Department of Internal Medicine, St. Louis University; Attending Physician, Veterans Administration Regional Office, St. Louis, Missouri. 2 Formerly Area Chief, Tuberculosis, St. Louis Medical Area, Veterans Administration; Department of Internal Medicine, Washington University, St. Louis, Missouri. Presently: Chief, Education & Training, Tuberculosis Service, Veterans Administration, Washington, D. C. 553
554
DEVINE
AND
DUNNER
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May.
1955
Vol.
XXVII
SAFER
PNEUMOPERITONEUM
REFILLS
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DUNNER
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1955
VoL
SAFER
XXVII
PNEUMOPERITONEUM
REFILLS
557
of time has elapsed between refills. By the use of this technique of traumatising the underlying visceral contents should be Acknowledgment: Merenda, Radiologist, and cooperation.
The authors wish to express and to Mr. L. F. Erting,
their x-ray
appreciation technician,
for
the danger minimized. to
Dr. their
Samuel assistance
J.
SUMMARY
As shown in the illustrations, the height of the abdominal air space in a patient with artifically induced pneumoperitoneum is increased on deep inspiration as compared with expiration. It is therefore concluded that for those patients receiving pneumoperitoneum refills in whom an appreciable air space is not present, the insertion of the needle at the end of a deep inspiration is a safer procedure to reduce the danger of injuring the abdominal viscera. RESUMEN
Corno se ha mostrado en las ilustraciones Ia altura del aire en el neumoperitoneo artificial, aumenta en Ia inspiraci#{243}n profunda en comparaci#{243}n con la expiraci#{243}n. Se concluye por tanto para los enfermos que reciben neumoperitoneo en los que una capa de aire no es apreciable, la inserci#{243}n de Ia aguja al final de una inspiraci#{243}n profunda es un procedimiento m#{225}s seguro para reducir el peligro de lesionar las vIsceras abdominales. RESUME
Comme ii est montr#{233} sur les planches, l’importance de Ia cavit#{233}a#{233}rique de l’abdomen chez un malade trait#{233} par pneumop#{233}ritoine est infiniment plus #{233}lev#{233}e dans l’inspiration profonde que dans l’expiration. Ii en r#{233}sulte que pour les malades a qui l’on insuffie un pneumop#{233}itoine, lorsqu’il n’y a pas de cavit#{233}gazeuse suffisante, il est plus sflr de faire Ia piqiire a Ia fin d’une inspiration profonde, afin de r#{233}duire le danger be blesser les visc#{232}res abdominaux. REFERENCE 1 Marmion, Tuberk,
T. M.: “Techniques 2:105, 1953.
des
reinsuffiations
du
pneumop#{233}ritoine,”
Schweiz.
Z.