Equis ISSN 2398-2977

Abdomen: peritoneal lavage

Contributor(s): Stephen Adams, Graham Munroe, Jarred Williams

Introduction

  • The introduction of abdominal drainage tubes for irrigation and drainage of peritoneal cavity.
  • An important and potentially life-saving technique in the treatment of peritonitis Abdomen: peritonitis.
  • Treatment of cases of septic peritonitis either as an adjunct to medical therapy or not responsive to medical therapy as determined by repeated abdominocentesis Abdomen: abdominocentesis.

Uses

  • Treatment of sepetic peritonitis Abdomen: peritonitis.
  • Peritoneal cleaning prior to laparotomy wound closure after intestinal surgery Intestine: resection and anastomosis Jejunum: jejunocecostomy.
  • Peritoneal irrigation and lavage post-operatively as a treatment for intra-operative contamination and/or a method to minimize adhesio formation.
  • An extension of paracentesis as a diagnostic procedure in the acute abdomen.

Advantages

  • Can be performed in the standing animal.
  • Removes/decreases bacteria, toxins, inflammatory products (degenerative neutrophils and cellular debris), enzymes, accumulated blood and foreign materials (eg plant material, urine) from the abdominal cavity.
  • Helps to reduce adhesions by diluting fibrinogen and fibrin, and mechanically separating intestines.
  • Mechanically cleans peritoneal cavity by using large quantities of non-irritating fluid.
  • Provides a simple means of monitoring response to treatment.
  • Provides a vehicle for the direct administration of therapeutic agents, eg antimicrobials, into the peritoneal cavity to achieve a high local level of the drug.
  • Provides a means of continuous drainage - lavage helps to maintain drain patency.

Disadvantages

  • May disseminate a local infection.
  • Infection may be introduced via drains.
  • Only a small portion of the abdominal cavity may be effectively lavaged - total lavage never occurs.
  • Drains/fluids may themselves act to create an inflammatory response.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good with sterile surgical technique and drain management for resolution of peritonitis when the primary source of infection has been eliminated.
  • Unknown for prevention of adhesion formation.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mair T S & Sherlock C E ( 2011) Surgical drainage and post operative lavage of large abdominal abscesses in six mature horses. Equine Vet J Suppl 43 (s39), 123-127 PubMed.
  • Nieto J E, Snyder J R, Vatistas N J, Spier S J & Van Hoogmoed L (2003) Use of an active intra-abdominal drain in 67 horses. Vet Surg 32 (1), 1-7 PubMed.
  • Hague B A et al (1998) Evaluation of post-operative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions. Vet Surg 27 (2), 122-126 PubMed.

Other sources of information

  • Debarainer R M (1996) Peritonitis. In:Large Animal Internal Medicine. Ed: Smith B P. Mosby, USA.


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