Peritoneal lavage

from Wikipedia, the free encyclopedia

Peritoneal lavage (also Abdominallavage , abdominal lavage , intraperitoneal lavage or abdominal lavage is) a term used in medicine and the flushing called the abdominal cavity with a diagnostic or therapeutic purpose.

execution

In principle there are three techniques: the open, the half-open and the Seldinger technique. The complication rate is 0.5 to 1%.

In humans, the abdomen is punctured four to five cm below the navel in the midline ( linea alba ) . The midline is relatively thin there, so that a harmless injury to the rectus abdominis muscle must be expected. Meticulous hemostasis is required when the transversalis fascia is reached. One liter of Ringer's solution at body temperature is infused through a catheter . The rinsing liquid then runs back into the bottle using the siphon principle .

In dogs and cats, the catheter is also inserted through a small incision behind the navel and advanced towards the pelvic cavity . As a guideline, 20 ml of fluid per kg of body mass are introduced.

Peritoneal lavage is contraindicated in the presence of an overgrowth or an intestinal obstruction .

Diagnostic peritoneal lavage

Peritoneal lavage was first used as a diagnostic method in 1965 by Root et al. carried out. In the 1970s, abdominal lavage was further developed by the Würzburg surgeon Ernst Kern into a method that improves the diagnosis of abdominal injuries. It was previously used to detect bleeding and organ injuries after accidents and rarely also in the context of staging in tumor patients, but has lost much of its importance in human medicine since the advent of modern imaging methods ( sonography , computed tomography ), but not in those with less technical equipment Countries and in veterinary medicine. In addition, recent studies show that peritoneal lavage in combination with a CT is much more sensitive than CT alone in detecting clinically inapparent organ injuries.

A negative result is a colorless, clear flushing liquid. A bloody rinsing fluid with more than 100,000 erythrocytes per µl is an indication of a manifest bleeding. Bile and stool , bacteria, amylase or bilirubin indicate an injury to the intestine or the gall bladder . If the result is positive, a laparotomy usually follows .

About 5% of the results of the lavage are each false negative (in the presence of adhesions, encapsulated injuries, diaphragmatic hernia with displacement of the injured organ into the chest cavity , incorrectly placed catheters) or in up to 10% of cases false positive (due to the lavage Catheter-induced bleeding, puncture of subperitoneal hematomas ).

Therapeutic peritoneal lavage

For therapeutic purposes, peritoneal lavage is carried out to remove toxins , enzymes and protein breakdown products, such as in the case of peritonitis . In addition, it can be used for perforation of internal organs. The lavage is also used for severely hypothermic patients in order to warm them up again.

In veterinary medicine, peritoneal lavage is also used in cases of severe uremia , for example in chronic kidney disease in cats , in order to wash substances from the body that require kidney disease . This peritoneal dialysis still plays a certain role in human medicine.

Individual evidence

  1. ↑ a b Jeffrey Norton et al. : Surgery: Basic Science and Clinical Evidence. Springer Science & Business Media, 2009, ISBN 978-0-387-68113-9 , p. 317.
  2. ^ Carol EH Scott-Conner: Operative Anatomy . Lippincott Williams & Wilkins, 2009, ISBN 9780781765398 , pp. 272-273.
  3. ^ Theresa Welch Fossum: Small Animal Surgery . 2nd edition 2002, p. 272.
  4. ↑ Ernst Kern: Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 24.
  5. ↑ a b c Bernhard Weigel, Michael L. Nerlich: Praxisbuch Unfallchirurgie . Springer, 2011, ISBN 9783642107894 , p. 104.
  6. ↑ Jeffrey Norton et al .: Surgery: Basic Science and Clinical Evidence . Springer Science & Business Media, 2009, ISBN 9780387681139 , p. 268.
  7. ↑ Jeffrey Norton et al .: Surgery: Basic Science and Clinical Evidence . Springer Science & Business Media, 2009, ISBN 9780387681139 , p. 317.
  8. ↑ Katharine Arnell and Sheri Ross, Advances in the Treatment of Chronic Kidney Disease in the Cat. In: Vet. Focus 19.3 (2009), pp. 6-14.
  9. ^ Sanabria M1 et al .: Dialysis outcomes in Colombia (DOC) study: a comparison of patient survival on peritoneal dialysis vs hemodialysis in Colombia. In: Kidney Int Suppl. 2008 Apr

See also