Chapter 147 Peritoneal Drainage Techniques
INDICATIONS FOR PERITONEAL DRAINAGE
Septic Peritonitis
Recommendations for abdominal drainage techniques in dogs and cats with septic peritonitis may be found in Box 147-1. In clinical practice, the author prefers to use CSD, even when criteria are met for primary closure. CSD allows not only for drainage of abdominal fluid that may accumulate but also for sampling of the abdominal fluid for cytologic analysis and confirmation that the inflammatory reaction and infectious process are indeed subsiding. Detailed descriptions of OPD and CSD techniques may be found later in this chapter.
Chemical Peritonitis
Peritoneal drainage plays important roles in both the preoperative and postoperative management of the dog or cat with uroperitoneum. In the preoperative setting, in addition to standard therapeutic measures to manage hypovolemia and hyperkalemia (see Chapters 55 and 137, Potassium Disorders and Hemodialysis and Peritoneal Dialysis, respectively), a peritoneal dialysis catheter or other fenestrated catheter in the peritoneal space will facilitate the evacuation of urine from the peritoneal cavity and the diversion of urine that continues to leak from the disrupted urinary tract until the patient is stable and surgical intervention can be performed. In the postoperative setting, because the likelihood of large particulate debris in the peritoneal space concurrent with uroperitoneum is unlikely, CSD (rather than OPD) will facilitate the evacuation of inflammatory exudates from the peritoneal cavity and should be necessary for only 1 to 3 days postoperatively in dogs and cats with moderate to severe generalized peritonitis.
Other Indications for Peritoneal Drainage
Reliable cannulae for infusion and drainage of fluid from the peritoneal space are critical to the practice of peritoneal dialysis. Two CSD catheters or other long-term peritoneal dialysis catheters may be placed laparoscopically or through a small laparotomy incision. Renal biopsy might be performed during the procedure (see Chapter 137, Hemodialysis and Peritoneal Dialysis).
Increased intraabdominal pressure has been documented in conditions including, but not limited to, portal hypertension, repair of chronic diaphragmatic hernia, abdominal counterpressure bandages, hemoperitoneum, and gastric dilatation-volvulus.4 Elevated intraabdominal pressure has generalized deleterious effects on the cardiovascular system, primarily mediated through decreased venous return and subsequent decreases in cardiac output. Local cardiovascular effects include decreased end-organ perfusion, both dependent and independent of the aforementioned effect on cardiac output. Increased intraabdominal pressure is also transmitted to the thoracic cavity via the diaphragm and may result in hypoxemia and hypoventilation. Peritoneal drainage may be indicated for animals with intraabdominal pressures higher than 30 cm H2O as measured with transurethral techniques.4 Box 147-2 lists conditions for which peritoneal drainage might be employed. Routine drainage of peritoneal fluid accumulations due to right heart failure, liver disease, or other noninflammatory or noninfectious processes is not indicated in the absence of increased intraabdominal pressure or respiratory embarrassment.*
