Artificial displacement of kidneys, spleen, and colon by injection of physiologic saline and CO2 as an aid to percutaneous procedures: experimental results.

PURPOSE

To determine whether displacement of the kidneys, spleen, or bowel with injection of fluids or CO2 can be used to create a direct and potentially safer access route to the retroperitoneum for large-bore needle biopsy or abscess drainage.

MATERIALS AND METHODS

In cadavers (n = 24), the kidneys were displaced laterally by means of computed tomography (CT)-guided paravertebral injection of 120 mL of physiologic saline solution (n = 18) and 120 cm3 of CO2 (n = 6). The spleen (n = 11) and retroperitoneal colon (n = 7) were also displaced with saline. Displacement of the organs from the needle tip was measured on CT scans.

RESULTS

After fluid injection the kidneys shifted 1.47 cm +/- 0.51, the spleen shifted 1.14 cm +/- 0.44, and the retroperitoneal colon shifted 1.38 cm +/- 0.37. The kidneys obstructed access to the para-aortic space in 17% of cases (four of 24 cases) and to the entire adrenal gland in 72% (13 of 18 cases) before saline injection and in 0% (zero of 24 cases) and 39% (seven of 18 cases), respectively, after injection. The result with fluid were significantly better than those with CO2 (P < .05).

CONCLUSION

Displacement of kidneys, spleen, or retroperitoneal colon with a saline injection is effective in gaining an access route for biopsy or abscess drainage. Potential for patient discomfort, decrease in target-lesion conspicuity, and adverse effects of absorbed fluid in patients with kidney or heart disease must be considered with use of this technique in the clinical setting.