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Use of Polyethylene Tubing in Presacral Pneumography
THE JOURNAL OF UROLOGY
Vol. 33, No. 5, May 1955 Printed in U.S.A.
USE OF POLYETHYLENE TUBING IN PRESACRAL PNEUMOGRAPHY GEORGE T. WOHL
AND
RALPH M. MYERSON
From the Departments of Radiology and Medicine, Veterans Administration Hospital, Philadelphia, Pa.
In 1947 Ruiz Rivas1 , 2 introduced the presacral approach for the induction of retroperitoneal pneumography. Since then numerous authors have attested to the safety of this procedure and its value in the roentgenographic demonstration of the kidneys, adrenal glands, spleen and liver. It has also been found to aid in the demonstration of primary and metastatic midline retroperitoneal neoplasms. Recently we have found that by using a polyethylene tube (fig. 1) for the delivery of the air or oxygen into the presacral tissues, some of the common difficulties associated with this procedure are eliminated. The use of the tubing is much more convenient for the operator and more comfortable for the patient. It eliminates the need for the continued presence of a needle in the retrorectal tissues and the necessity for repeated or continuous rectal examination to insure the proper position of the needle. The tubing greatly facilitates the injection of air or oxygen under fluoroscopic guidance and enables the patient to be moved with greater ease so that the gas may be delivered to the desired area. If fluoroscopy is desired, the tubing may be inserted outside the radiology department and the patient then transported to the fluoroscopic room for the necessary studies. EQUIPMENT REQUIRED
Eighteen inches of No. 50 polyethylene catheter tubing sterilized manner. No. 16 three-inch needle. Three-way stopcock. One 50 cc syringe. One inch No. 22 hypodermic needle. Local anesthesia tray. Gloves, sterile towel for drapes, skin antiseptic, etc.
111
usual
TECHNIQUE*
With the patient in the knee-chest position, the skin adjacent to the tip of the coccyx is cleaned and infiltrated with a local anesthetic. A 3-inch 16 gauge needle is inserted just distal and slightly to one side of the tip of the coccyx and directed obliquely upward, inward and forward in such a manner that its point Accepted for publication October 7, 1954. 1 Ruiz Rivas, M.: Nueva tecnica de diagnostico radiografico aplicable a organos yestructuras retroperitoneales, mediastinicas y cervicales. Rev. clin. espan., 25: 206, 1947. 2 Ruiz Rivas, M.: Roentgenographic diagnosis; generalized subserous emphysema throu11;h single puncture, Am. J. Roentgenol., 64: 723, 1950. * The use of a somewhat similar technique was reported by Dr. Hans H. Zinsser in Archives of Surgery, 69: 736, 1954. 883
884
GEORGE T. WOHL AND RALPH M. MYERSON
Fm. 1. Equipment required for presacral pneumography with polyethylene tubing
comes to rest in the retrorectal fatty areolar tissue. An examining finger in the rectum is used to palpate the point of the needle and insure its proper position. An 18-inch length of No. 50 polyethylene tubing is threaded through the needle as far as possible, the latter carefully removed, and the tubing strapped to the patient. A I-inch No. 22 hypodermic needle serves as a satisfactory adaptor between the tubing and 3-way stopcock. Following preliminary aspiration to make sure that a blood vessel has not been entered, air or oxygen is injected. By rocking the fluoroscopic tilt table, or turning the patient from side to side the gas may be guided into the desired location during fluoroscopy. Supine anterior-posterior and lateral films are taken, the patient removed from the table with the catheter in situ. These are immediately developed and, if satisfactory, the catheter is removed. If not, more gas may be injected as required. CONCLUSIONS
A modified method of retroperitoneal air or oxygen insufll.ation by the presacral route has been described. The method involves the use of a polyethylene tubing for the delivery of the gas. This technique is admirably suited for use with fluoroscopy.
Vol. 33, No. 5, May 1955 Printed in U.S.A.
USE OF POLYETHYLENE TUBING IN PRESACRAL PNEUMOGRAPHY GEORGE T. WOHL
AND
RALPH M. MYERSON
From the Departments of Radiology and Medicine, Veterans Administration Hospital, Philadelphia, Pa.
In 1947 Ruiz Rivas1 , 2 introduced the presacral approach for the induction of retroperitoneal pneumography. Since then numerous authors have attested to the safety of this procedure and its value in the roentgenographic demonstration of the kidneys, adrenal glands, spleen and liver. It has also been found to aid in the demonstration of primary and metastatic midline retroperitoneal neoplasms. Recently we have found that by using a polyethylene tube (fig. 1) for the delivery of the air or oxygen into the presacral tissues, some of the common difficulties associated with this procedure are eliminated. The use of the tubing is much more convenient for the operator and more comfortable for the patient. It eliminates the need for the continued presence of a needle in the retrorectal tissues and the necessity for repeated or continuous rectal examination to insure the proper position of the needle. The tubing greatly facilitates the injection of air or oxygen under fluoroscopic guidance and enables the patient to be moved with greater ease so that the gas may be delivered to the desired area. If fluoroscopy is desired, the tubing may be inserted outside the radiology department and the patient then transported to the fluoroscopic room for the necessary studies. EQUIPMENT REQUIRED
Eighteen inches of No. 50 polyethylene catheter tubing sterilized manner. No. 16 three-inch needle. Three-way stopcock. One 50 cc syringe. One inch No. 22 hypodermic needle. Local anesthesia tray. Gloves, sterile towel for drapes, skin antiseptic, etc.
111
usual
TECHNIQUE*
With the patient in the knee-chest position, the skin adjacent to the tip of the coccyx is cleaned and infiltrated with a local anesthetic. A 3-inch 16 gauge needle is inserted just distal and slightly to one side of the tip of the coccyx and directed obliquely upward, inward and forward in such a manner that its point Accepted for publication October 7, 1954. 1 Ruiz Rivas, M.: Nueva tecnica de diagnostico radiografico aplicable a organos yestructuras retroperitoneales, mediastinicas y cervicales. Rev. clin. espan., 25: 206, 1947. 2 Ruiz Rivas, M.: Roentgenographic diagnosis; generalized subserous emphysema throu11;h single puncture, Am. J. Roentgenol., 64: 723, 1950. * The use of a somewhat similar technique was reported by Dr. Hans H. Zinsser in Archives of Surgery, 69: 736, 1954. 883
884
GEORGE T. WOHL AND RALPH M. MYERSON
Fm. 1. Equipment required for presacral pneumography with polyethylene tubing
comes to rest in the retrorectal fatty areolar tissue. An examining finger in the rectum is used to palpate the point of the needle and insure its proper position. An 18-inch length of No. 50 polyethylene tubing is threaded through the needle as far as possible, the latter carefully removed, and the tubing strapped to the patient. A I-inch No. 22 hypodermic needle serves as a satisfactory adaptor between the tubing and 3-way stopcock. Following preliminary aspiration to make sure that a blood vessel has not been entered, air or oxygen is injected. By rocking the fluoroscopic tilt table, or turning the patient from side to side the gas may be guided into the desired location during fluoroscopy. Supine anterior-posterior and lateral films are taken, the patient removed from the table with the catheter in situ. These are immediately developed and, if satisfactory, the catheter is removed. If not, more gas may be injected as required. CONCLUSIONS
A modified method of retroperitoneal air or oxygen insufll.ation by the presacral route has been described. The method involves the use of a polyethylene tubing for the delivery of the gas. This technique is admirably suited for use with fluoroscopy.