peritoneal lavage (therapeutic)

Last reviewed 01/2018

Therapeutic peritoneal lavage is an ancillary form of treatment for peritonitis. There are at least two methods:

• operative: a long vertical incision is made in the abdomen and the essential reparative surgical procedures are carried out
• any free pus or faeces is removed
• the bowel is gently drawn out of the abdomen, fibrinous plaques are removed, and the bowel and the cavity are washed; special care is taken to wash the subphrenic, subhepatic and paracolic areas
• warm normal saline, with the possible addition of 1 gram per litre of tetracycline, is poured into the abdominal cavity, sucked out, and then a second administration is applied
• the wound is closed

• continuous irrigation: two catheters are inserted into the abdomen:
• a Tenckhoff peritoneal dialysis catheter is inserted deep into the pelvis
• a standard catheter, or alternatively a drain, is inserted into one of the paracolic gutters depending on the site of maximal sepsis
• normal saline or peritoneal dialysis fluid is introduced through the pelvic catheter and drained out through the paracolic gutter
• the most common use for this is the treatment of a necrotic pancreas

Occasionally, the former laparotomy approach is supplemented by the latter technique after closing the abdomen.