Drainage of retroperitoneal space

Drainage is usually necessary in order to remove fluid from body cavities, from wounds and abscesses. When carrying out drainage, use tubes of different materials, bundles of threads( silk, catgut) with gauze strips. In the treatment of infected wounds, drainage tubes have been used for a long time( Para-Celsius, Galen, Hippocrates), but after Ruben Chassenyak's proposal, rubber tubes were used as a working material.

Draining of the abdominal cavity.

It happens that peripancreatic inflammatory process complicates the operation in full. To eliminate this problem, the operation is also used - drainage of the retroperitoneal space.

One way of draining is known in surgery. It consists in the fact that after carrying out a laparotomy through the gastroduodenal ligament they are inserted into the stuffing box. From the lower edge of the pancreas, the parietal peritoneum is dissected, including the anterior sheet of the fascia of the pancreatoduodenal complex.

The pancreas exfoliates from the underlying fiber. Further along the back line in the right lateral region of the abdomen at level 12, the ribs dissect the retroperitoneal fascia, after which they enter the anterior circumferential cellular space that lies between the fascia of Toldt and the primary ascending colon peritoneum. Through the counter-texture in a blunt way, namely the fingers make a canal in the area of ​​the duodenum under the descending section to the location of the pancreas. In this box, a drainage tube is inserted. The next step is that through the contracepture of the right abdominal region in the lateral part of the abdomen, another drainage tube is conducted into the circumflex space located between the Toldt's fascia and the front right prepenal fascia. The tube is inserted before the projection of the pancreas. The same counterperature is created on the left side of the abdomen, a drainage tube is installed here. In other words, the space of the abdominal cavity is drained.

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Disadvantages of drainage.

However, this method has some drawbacks. One of the significant drawbacks is that often drainage is performed blindly.

The main task during the operation to exclude the occurrence of complications from general anesthesia.

This can be achieved with the help of color ultrasound mapping of large vessels, including organs that are located in the lumbar region. Under his control, local infiltration anesthesia is performed at the points of intersection of the long back muscle and the 12th rib. The puncture needle moves forward until it enters the purulent focus. Next, the skin is cut, the trocar needle together with the drainage conducts color ultrasound mapping of large vessels, including organs that are located in the lumbar region. Under the control, local infiltration anesthesia is performed at the intersection points of the length of the back muscle with 12 ribs. The puncture needle moves forward until it enters the purulent focus. Then the skin is cut and a trocar is inserted with drainage into the purulent focus. Drainage is fixed on the skin.

Avoidance of damage during local infiltration anesthesia, with further drainage of the retroperitoneal space, is facilitated by color ultrasound mapping of organs located in the lumbar region and large vessels. For access to the retroperitoneal space, the optimal location is the point of intersection of the length of the back muscle and 12 ribs. This site is also considered to be the safest place for the puncture needle and further installation of drainage.

The drainage of the retroperitoneal and abdominal space is performed under local anesthesia to avoid any postoperative complications that occur after general anesthesia.

The way of draining the retroperitoneal space.

First, color ultrasound mapping of large vessels, as well as organs in the lumbar region, is performed. Under the control of color mapping, local infiltration anesthesia is carried out at the intersection point with the length of the back muscle and 12 ribs. The puncture needle moves forward into the purulent focus located in the retroperitoneal space. Next, the surgeon takes a pointed scalpel and cuts the skin to further introduce the trocar head with a drainage tube into the purulent focus. After the introduction of the needle with drainage, the mandrone is removed, the drainage is fixed on the skin.

Example of drainage.

Here is one clinical example. One patient was taken to the hospital. When examining ultrasound and computed tomography, the patient showed signs of pancreatonecrosis. In some places, abscessed areas were observed. On the left, there was a breakthrough into the retroperitoneal space. The diagnosis was as follows: acute destructive pancreatitis in the phase of purulent-necrotic complications, left-sided retroperitoneal phlegmon.

The patient underwent color ultrasound mapping of large vessels, including organs that are located in the lumbar region. Under his supervision, the surgeon conducted a local infiltration anesthesia at the point of intersection of the long muscle with the 12th rib. The puncture needle was advanced until it penetrated the purulent focus, the skin was dissected and then a 8 mm diameter trocar needle was inserted which was equipped with drainage. Drainage was established during the course of infiltration into the purulent focus itself. Then the drainage was fixed on the skin.

We have got the formula for drainage of retroperitoneal space during the treatment of destructive pancreatitis, which is complicated by retroperitoneal phlegmon. The formula is as follows: ultrasound color mapping of larger vessels, including organs that are located in the lumbar region. Further local infiltration anesthesia is carried out at the point of intersection of the long muscle with the 12th rib. The puncture needle moves forward until it penetrates into the purulent focus, then the skin is cut and a trocar with drainage is inserted. Drainage is fixed on the patient's skin.