RU174544U1 - DEVICE FOR ASPIRATION OF LIQUID FROM ABDOMIC CAVITY - Google Patents

Abstract

A device for active aspiration of fluid from the abdominal cavity, including a holkon with a thickness of 0.5-1 cm and two sheets of film with holes with a diameter of 0.2-0.7 cm with a frequency of 4-16 holes per 1 dm, connected via an vinyl aspiration apparatus to an active aspiration apparatus, characterized in that the holkon is made in the form of a square measuring 50 cm, and silacryl is used as the insulating holkon film. The proposed device is simpler than the known one.

Description

The proposed utility model relates to medical equipment, namely to devices for surgical operations, and may find application in aspiration of fluids from the abdominal cavity.

The problem of removing fluid from the abdominal cavity is especially relevant in the treatment of peritonitis.

A device for aspirating fluid from the abdominal cavity during laparoscopic surgery (see RF patent No. 2178317, IPC A61M 27/00, publ. 01.20.2002), consisting of an insufflator, a fluid receiver, a vacuum pump, a system of tubes and trocars, in which the receiver liquids and a vacuum pump through a system of tubes and trocars form a vicious circle with the abdominal cavity.

The disadvantage of this device is that it is designed for occasional removal of fluid in a short period of time and does not guarantee complete evacuation of fluid from the abdominal cavity.

Closest to the claimed device is a patent for PM of the Russian Federation No. 126587 "Device for active aspiration of fluid from the abdominal cavity", IPC A61B 17/00. publ. 04/10/2013. This device contains soft drainage, consisting of 2-4 strips of hollcon, 65-75 cm long, 5.0-6.0 cm wide and 0.5-1.0 cm thick, laid crosswise and soldered into 0.2 perforated polyethylene -0.7 cm with a frequency of 4-16 holes per 1 dm ² , connected through a vinyl chloride tube to an apparatus for active aspiration.

The disadvantage of this device, which is the prototype of the attached one, is the difficulty of preparing the hollcon and fixing the latter by soldering between sheets of polyethylene.

The objective of the utility model is to simplify it and reduce the complexity of manufacturing the device.

The problem is solved by a device for active aspiration of fluid from the abdominal cavity, including a hollcon sheet with a thickness of 0.5-1 cm and 2 sheets of an insulating film with a hole of 0.1-0.2 cm with a frequency of 4-16 holes per 1 dm ² attached to vacuum source through a vinyl tube.

Distinctive features of the utility model is that the holcone sheet has a square shape of 50 cm square, and silacryl is used as the insulating holcon film.

Silacryl has an adhesive coating, which reduces the complexity of fixing the holklon and the vinyl chloride tube and increases the reliability of its fixation.

The device is used as follows. Soft drainage is collected, for which a continuous hollcon is placed between the layers of silacryl.

The source of peritonitis is eliminated and the abdominal cavity is sanitized, then the soft drainage is placed in the abdominal polo, the drainage canal is formed by introducing the chlovinyl drainage tube into the aspiration wound, the abdominal cavity is sealed with a sterile film, the drainage tube is connected to the vacuum discharge source, and the aspiration system is set up.

Clinical example.

Patient L, 69 years old, was admitted to the admission department of the City Clinical Hospital named after A.K. Eramishantseva 10/11/2016 with complaints of pain in all sections of the abdomen, bloating, repeated vomiting of intestinal contents, fever 38.6. The above complaints appeared 2 days ago and gradually increased.

From the anamnesis, it is known that the patient suffers from chronic obstructive pulmonary disease of a severe course (smoking history of more than 40 years), severe bronchial asthma (14 years old takes corticosteroids with the development of Cushing's syndrome and osteoporosis), type 2 diabetes mellitus, hypertension.

Objectively: the condition is serious, the skin is pale, dry. No peripheral edema. Breathing is hard, carried out in all departments, BH - 20 per minute. Heart sounds are muffled, blood pressure is 100/70 mm Hg. Pulse - 115 beats. in minutes The tongue is dry, coated with a white coating. The abdomen is swollen, tense, painful in all departments. Peristalsis is not heard. Peritoneal symptoms throughout the abdomen. Gases do not leave for two days. The chair is absent for three days. I urinated the last time the night before, in a small amount.

Ultrasound of the abdominal cavity: a moderate amount of heterogeneous fluid in the abdominal cavity.

X-ray of the chest and abdomen: Hydropneumothorax at the time of the study was not detected. Emphysema. Diffuse pneumosclerosis. No free gas or fluid levels were found in the abdominal cavity. Pneumatosis of the small and large intestine.

 The results of blood tests - Hb 113 g / l, white blood cells - 18.2 * 10 9 / l.

Diagnosis: Common peritonitis.

The patient was sent to the operating room, where the central vein was catheterized, 2 grams of ceftriaxone was administered, and infusion therapy was started.

During catheterization of the bladder, 80 ml of concentrated urine was obtained.

After a brief intensive preoperative preparation, the operation is started. Under endotracheal anesthesia, a wide median laparotomy was performed. In all parts of the abdominal cavity there are accumulations of pus. Parietal and visceral peritoneum with severe edema, strata of fibrin. Loops of the small intestine are a single conglomerate, upon separation of which multiple interintestinal abscesses with a total volume of up to 300 ml have been opened. During a revision of the pelvis, a fetid abscess with an admixture of intestinal contents of 500 ml was opened. The sigmoid colon is fixed in the pelvis. After its isolation, it was found that on the anti-mesenteric edge of the sigmoid colon 20 cm from the pelvic peritoneum there is a spot of necrosis 2 cm in diameter with perforation, from which the intestinal contents leak. Palpation throughout the sigmoid colon determines multiple diverticula. The situation is regarded as diverticular disease, diverticulitis, perforation of the sigmoid colon diverticulum, common fecal peritonitis with fragmentation. Performed obstructive resection of the sigmoid colon with suturing of both ends tightly. Given the prevalence of the purulent process in the abdominal cavity, the high virulence of the putative flora and the fragmentation of pus, a decision was made to multi-stage treatment of the patient with active laparostomy. The abdominal cavity is sanitized. A device for active aspiration of fluid is installed in the stomach, consisting of two sheets of silacryl having point perforations over the entire surface, between which a hollcon layer is fixed. A drain wrapped in a gauze napkin is connected to the device. The wound is sealed with a sticky surgical film. The drainage is connected to a vacuum source of 120 mm Hg. Permanent aspiration of fluid has been established.

For further treatment, the patient was transferred to the intensive care unit, where continuous aspiration of fluid from the abdominal cavity was carried out, as well as a comprehensive treatment, including prolonged mechanical ventilation, infusion and antibacterial therapy, and pain relief.

For 24 hours of intensive treatment, the patient's condition remained stable and severe. 700 ml of turbid liquid was removed from the abdominal cavity.

12.10.2016, 30 hours after the initial operation under endotracheal anesthesia, programmed rehabilitation of the abdominal cavity was performed. Dressings removed from the wound. In the abdominal cavity there are traces of odorless turbid fluid. Intestine loops are moderately hyperemic traces of fibrin. The muffled ends of the intestines are wealthy. Marked positive dynamics compared with the primary operation. The situation is regarded as resolving peritonitis. A decision was made to close the abdomen with the removal of the sigmoid. The laparotomic wound is sutured with rare sutures through all layers.

The next three days, the patient was treated in the intensive care unit, against which the condition improved - in consciousness, hemodynamically stable, breathes independently, pink sigmoid, functioning.

On the fourth day after the closure of the laparostomy, the patient was transferred to the surgical department, where treatment was continued.

On the 15th day after the closure of the laparostomy, the patient was discharged for outpatient aftercare in a satisfactory condition.

This clinical example clearly demonstrates the effectiveness of the active laparostomy, a key element of which is a device for active aspiration of fluid from the abdominal cavity, consisting of two sheets of perforated silacrylic film, between which a sheet of hollcon is fixed.

Claims (1)

A device for active aspiration of fluid from the abdominal cavity, including a hollcon sheet with a thickness of 0.5-1 cm and 2 sheets of insulating film with holes with a diameter of 0.1-0.2 cm with a frequency of 4-16 holes per 1 dm ² , connected to a source of discharge through a vinyl chloride tube, characterized in that the holcon sheet is square in shape with a size of 50 cm ² , and silacryl is used as the insulating holcon film.