• 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.

Technical problems

• Possible damage to abdominal organs when drains are inserted in standing animal.

Alternative techniques

• See Abdomen: peritonitis Abdomen: peritonitis.

Procedures

• 3 alternatives/techniques:
  • Retrograde irrigation and drainage via a ventral midline ingress/egress catheter positioned at most dependent point of abdomen - most effective for removal of peritoneal exudate.
  • Similarly, a continuous fenestrated drain can be placed surgially along the left paramedial body wall through cranial and caudal stab incisions. The drain runs intra-abdominally between the two incisions and represent ingress/egress in either direction.
  • Ingress catheter(s) in paralumbar fossa(e) and egress catheter on ventral midline - may be less effective as fluid will travel a direct path between catheters and may limit lavage.

Time required

Preparation

• Sedation, local anesthesia: 10-15 min.
• Aseptic preparation: 10-15 min.

Procedure

• Drain insertion: 5-10 min.
• Peritoneal lavage: at least 30 min.

Decision taking

Criteria for choosing test

• Peritonitis: used for the treatment of cases of septic peritonitis as an adjunct to medical therapy or those not responsive to medical therapy as determined by repeated abdominocentesis Abdomen: abdominocentesis.
• An extension of paracentesis as a diagnostic procedure in the acute abdomen.
• Drain placed intra-operatively during intestinal surgery to provide post-operative drainage after recovery from anesthesia.

Risk assessment

• Presence of gastrointestinal viscous along body wall where drain placement is desired - can be determined via ultrasonographic evaluation.