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.