One of the diagnostic methods for dropsy of the abdominal cavity is laparocentesis. With ascites, this procedure is the most informative. The procedure itself is a simple surgical manipulation to puncture the abdomen and take the contents for the purpose of laboratory research.
What is abdominal laparocentesis
With ascites, this type of diagnostic surgical intervention is necessary to clarify the nature of the contents in the peritoneum. The first attempts to implement the procedure were made in the century before last. Then the doctors tried to pierce the abdomen with a pathological increase in its volume. Ascites laparocentesis helped establish gallbladder rupture after trauma to the abdominal cavity. In the middle of the last century, the technique was actively mastered by surgeons in different countries. Today, manipulation is not only one of the most informative and effective, but also safe for humans.
Nowadays, such a surgical operation is performed not only with ascites. Abdominal laparocentesis is often resorted to if necessary, an accurate examination of patients after injuries, with suspected bleeding, perforation of the intestinal wall. Due to the low invasiveness and minimal trauma, complications do not develop after laparocentesis. The main thing is compliance with aseptic rules and the exact technique of performing manipulations by a surgeon.
Who is recommended for manipulation
Puncture of the abdominal cavity is prescribed solely for the purpose of diagnosis and making an accurate reliable diagnosis with a blurred clinical picture. Separate techniques for laparocentesis in ascites make it possible to use this procedure for the treatment of pathology by fluid evacuation. Research puncture can be called curative if, in addition to detecting an abnormal formation, the surgeon will immediately remove it.
Laparocentesis is performed on an outpatient basis, in the inpatient department they resort to it in case of traumatic injuries and an unclear diagnosis. The procedure is carried out not only with ascites. Other pathological conditions can serve as indications for laparocentesis:
- suspected internal bleeding in the abdomen;
- peritonitis;
- perforation of the intestinal walls as a result of closed injuries;
- perforation of a stomach ulcer or duodenal ulcer;
- cyst rupture;
- blunt abdominal injuries in a patient in a coma, heavy alcohol or drug intoxication and not able to indicate specific symptoms;
- numerous injuries in a person unconscious if serious injuries and rupture of internal organs have occurred;
- wounds with penetration into the sternum due to the risk of damage to the diaphragm.
Liquid material obtained through a puncture of the abdominal cavity is sent to a laboratory study. Ascitic exudate should be studied in detail for impurities of blood, pus, feces, urine, bile and gastric juice.
Contraindications
In some cases, surgical intervention in the abdominal cavity is unacceptable because of the high probability of adverse effects in ascites. Laparocentesis is often the only research option, especially when other diagnostic methods are not sufficiently informative about the contents of the abdominal cavity.
A puncture of the abdomen is contraindicated in:
- blood coagulation diseases due to high risks of bleeding;
- complicated adhesive disease;
- severe bloating;
- recurrent umbilical or epigastric hernia;
- intestinal obstruction;
- the likelihood of trauma to the intestine or tumor;
- pregnancy.
Laparocentesis should be carried out with extreme caution in the area close to the bladder, as well as organs that are enlarged. It is worth noting that the presence of adhesions is not an absolute contraindication for the implementation of manipulation. The thing is that pathology in itself causes a high probability of damage to blood vessels and neighboring organs. Indications for laparocentesis in ascites should be evaluated by a doctor individually.
Is it possible to pierce the stomach at home
In preparation for the planned intervention in the abdominal cavity with ascites, the laparocentesis technique is selected individually. The patient is prescribed preliminary standard examinations. The patient should undergo general urine and blood tests, a coagulogram, undergo an ultrasound of the internal organs and, if the doctor considers it necessary and necessary, an X-ray with a contrast medium.
Laparocentesis of the abdominal cavity with ascites at home is not performed. The degree of preparation for laparocentesis is close to that required before any other surgical intervention. In addition, the surgeon performing the manipulation should always be ready for the transition from diagnostic laparocentesis to therapeutic laparotomy.
How to prepare for the patient
The day before the surgery, the patient should refuse food, and immediately before the manipulation empty the bladder, intestines and stomach. In case of serious injuries and blunt injuries of the abdomen, accompanied by shock or coma, mechanical ventilation is carried out. With ascites, laparocentesis is performed in the operating room, where there is always the opportunity to urgently go over to an open surgical procedure.
A puncture of the abdomen is carried out with local anesthesia, and there is no need for general anesthesia, according to doctors. According to some patients, prior to laparocentesis in ascites, premedication is performed, which is indicated for people with mental disorders, as well as for especially impressionable and nervous persons. The essence of premedication is the preliminary administration of a subcutaneous injection of Atropine Sulfate, Promedol, Lidocaine or Novocaine.
Before the puncture, the patient should undergo a test for sensitivity to anesthetics, since most painkillers cause allergic reactions. To ensure the safety of the chosen product, a light scratch on the skin of the forearm of the patient with a sterile needle and a couple of drops of the medicine. If after 20-30 minutes no reaction has occurred, including the color of the skin, the itch and swelling are absent, the test is considered successful. With a positive reaction, accompanied by redness of the skin, the anesthetic is changed.
About laparocentesis technique
To implement this procedure, special medical instruments will be required. A puncture of the abdominal wall is carried out using a special trocar, a tube for draining fluid, syringes and clamps. Ascitic fluid extracted from the abdomen is collected in a sterile container, which will subsequently be sent for bacteriological examination. The surgeon must use sterile gloves.
The technique of laparocentesis in ascites implies a sitting position of the patient, but in some cases, surgery is possible lying on his back. Oilcloth, a disposable diaper are placed under his buttocks. For the surgeon, such manipulation is not particularly difficult. Before the puncture, the place of intended access is treated with an antiseptic solution.
A puncture is done in the middle of the abdomen, backing 2-3 cm down from the navel, sometimes a little to the left. Much less often, the needle is launched at the midpoint between the navel and the pubic region. Before penetrating the trocar into the abdominal cavity, the doctor makes a minor incision with a scalpel to dissect the skin, a layer of subcutaneous fat and muscle. The surgeon should act as carefully as possible so that an accidentally slipped scalpel does not damage the inside. Today, surgeons are increasingly starting an operation with tissue expansion using a blunt method, without using a knife.
As the trocar moves deeper into the cavity, the surgeon's task is to timely stop the bleeding from the vessels of the skin and fiber. Otherwise, errors in the results of the study of ascitic fluid are not excluded. The trocar is sent to the peritoneal opening at an acute angle of 45 ° with respect to the xiphoid process of the sternum. The doctor should provide space for the needle to penetrate by grabbing the umbilical ring and slightly raising the abdominal wall. The correct technique for performing laparocentesis in ascites will allow the puncture to be performed safely for the patient. Often in the process, surgeons use a special thread that is inserted into the abdominal puncture area through the aponeurosis of the rectus abdominis muscle. By attaching a surgical thread to this muscle, it becomes possible to raise the soft tissues of the abdomen.
Features of the procedure
The technique of performing laparocentesis in ascites of the abdominal cavity does not interfere with manipulation on an outpatient basis. The introduction of the needle is carried out according to the previously described principle. As soon as their cavity appears liquid, the instrument is tilted to a container prepared in advance. During the outflow of fluid, it is important to hold the distal end with your fingers so that it does not come off.
With ascites, abdominal fluid cannot be removed too quickly. The rapid loss of ascitic water can lead to a sharp decrease in blood pressure, in severe cases, up to collapse. This is due to a sharp redirection of blood through the vessels of the abdominal cavity, which had previously been squeezed by a liquid. To prevent such a complication, the liquid is removed slowly - 400 ml every hour. In this case, the patient is not disregarded. Near it should be constantly the staff of the medical facility. The surgeon’s assistant during the procedure, as the abdominal volume decreases, tightens the abdominal cavity with a towel in order to prevent hemodynamic disorders.
After the final removal of ascitic fluid, the needle is carefully removed, and the incision is sutured and a sterile dressing is applied. A squeezing towel is undesirable to remove, since at first it will help to create the correct intra-abdominal pressure and help the patient get used to the new conditions of blood supply. In the case of leaving the tube for a phased evacuation of fluid, the patient should periodically change the position of the body to improve the outflow of fluid.
What is the difference between diagnostic laparocentesis?
If the decision to conduct this manipulation was made with the aim of a complete examination of the patient, the procedure will be a little different. In order to detect abnormal contents in the abdominal cavity, the surgeon uses a so-called poking catheter. It connects to a syringe that aspirates ascites exudate. If the syringe remains empty, then saline (approximately 300 ml) is injected into the stomach, then it is removed and sent for examination.
If during the implementation of the manipulation it is necessary to examine the internal organs, then a laparoscope is placed in the tube of the trocar. The doctor, detecting severe damage, can decide on surgical treatment directly during laparocentesis. In this case, the diagnostic procedure takes the scale of a serious cavity intervention.
Laboratory analysis of fluid from the abdomen
Upon completion of laparocentesis, the resulting content is sent for research to the laboratory. There, not only the appearance of the liquid mass is evaluated, but also a conclusion is drawn up on its biochemical parameters. If blood is detected in the biomaterial, there are elements of feces or impurities of urine, the patient must be operated on urgently. The purulent gray-green or yellowish color characteristic of peritonitis can also cause serious concern. Such an appearance of the abdominal fluid obtained during laparocentesis may indicate intra-abdominal bleeding, perforation of the intestinal wall or stomach, purulent-inflammatory or necrotic process, which means only one thing: you can not lose a minute.
Recognize bleeding in the study of liquid mass from the patient’s abdomen by the admixture of red blood cells and white blood cells. By the way, with the help of laparocentesis, tests can be performed to clarify whether the bleeding was stopped or not. In this case, the presence of blood particles in an insignificant volume may be a false positive sign of active bleeding.
If urine is detected in the ascitic exudate, most likely there is a rupture of the bladder wall. The presence of feces is a direct confirmation of perforation of the intestinal wall. The cloudy appearance of the fluid and a large percentage of fibrin (protein) in it indicates peritonitis, which is an indication for emergency surgical treatment.
A puncture of the abdomen is most often done with ascites. Laparocentesis can be indicated even with a stable condition of the patient and the absence of pathological contents in the abdomen, if the fact of a blunt trauma to the abdomen does not exclude the possibility of organ damage or bleeding. So, for example, with rupture of the spleen or hematoma of the liver, their increase in size and the outflow of blood into the cavity is possible. In such cases, the surgeon establishes silicone drainage after laparocentesis for two days, ensuring a normal outflow of fluid.
Complications after laparocentesis
The negative consequences of manipulation develop in exceptional cases. Most likely, an infectious process can develop at the puncture site while ignoring aseptic rules. In patients with severe liver and gastrointestinal diseases, there is a risk of phlegmon of the abdominal wall. If the doctor damages large vessels, internal bleeding is not ruled out. The cause of damage to internal organs after laparocentesis may also be the carelessness of the surgeon.
An unfavorable consequence of laparocentesis of the abdominal cavity with ascites can be collapse and bleeding against the background of prolonged flow of ascitic fluid after puncture. In this case, the postoperative period always proceeds without complications, since this intervention does not require the use of general anesthesia and significant tissue damage. Sutures after laparocentesis are removed a week after surgery. After a puncture of the abdomen, the patient is recommended to refrain from physical exertion, adhere to dietary restrictions and observe bed rest.