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Intestinal lavage is a bowel lavage.
Last reviewed: 04.07.2025
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The most reliable way to cleanse the intestines of toxic substances is considered to be washing them using probing and the introduction of special solutions - intestinal lavage, or intestinal lavage.
The therapeutic effect of this method lies in the possibility of direct cleansing of the small intestine, where, during late gastric lavage (2-3 hours after poisoning), a significant amount of the toxicant is deposited and continues to enter the blood.
[ Methodology for performing intestinal lavage
To perform intestinal lavage, a two-channel silicone probe (about 2 m long) with a metal mandrel inserted into it is inserted into the patient's stomach through the nose. Then, under the control of a gastroscope, this probe is passed at a distance of 30-60 cm distal to the Treitz ligament, after which the mandrel is removed. A special saline solution identical in ionic composition to chyme (substitute) is introduced through the opening of the perfusion channel located at the distal end of the probe.
In cases of hyperhydration of the body (renal failure, extensive perifocal edema in inflammation, other cases of local or systemic hyperhydration), a solution is used whose osmolarity exceeds the plasma osmolarity. In cases of increased permeability of the capillary wall (shock, acidosis, allergy, etc.), the osmolarity of the solution should correspond to the osmolarity of the plasma. In such cases, the patient's plasma COP is first determined, then a solution is prepared for him whose osmolarity is higher than or equal to the plasma osmolarity. Description of the intestinal lavage technique.
Intestinal lavage procedures differ technically and methodologically from each other depending on the indication and the patient's condition.
Method No. 1 (continuous intestinal lavage)
In cases of acute oral poisoning and endotoxicosis in unconscious patients, intestinal lavage is performed in the following manner.
A two-channel nasojejunal tube is inserted into the patient under endoscopic control. A saline electrolyte solution heated to 38-40 °C is injected into one of the tube channels using a pump at a rate of 60-200 ml/min. After some time, the patient develops diarrhea, with some of the solution flowing out through the second tube channel. The toxic substance that caused the poisoning is removed along with the intestinal contents. To enhance detoxification of the body, intestinal lavage is combined with enterosorption, introducing a suspension of powdered enterosorbent in an amount of 70-150 g using a syringe through the aspiration (wide) tube channel. The intestines are washed until the enterosorbent appears in the rinsing water obtained from the rectum, or until the rinsing water is clear and no longer contains poison. The total volume of the solution used is 30-60 l or more (up to 120 l). As a result of intestinal lavage, the symptoms of intoxication undergo a reversal.
Possible complications of intestinal lavage in the form of traumatic damage to the gastrointestinal mucosa due to intestinal probing (5.3%), vomiting and aspiration (1.8%), hyperhydration (29.2%) can be minimized with strict adherence to the technique. Hyperhydration can be easily eliminated with the UV apparatus "artificial kidney".
Method No. 2 (fractional intestinal lavage)
For patients in a serious condition that precludes the possibility of independent administration of the solution, intestinal lavage is performed through a single-channel nasogastric or nasoduodenal tube. A saline electrolyte solution with an osmolarity equal to the osmolarity of the patient's blood is used.
The temperature of the solution is 37-38 °C. To prevent regurgitation and aspiration of gastric contents, it is necessary to select an adequate rate of administration of the solution, excluding overfilling of the stomach, elevated position of the upper half of the patient's body and tracheal intubation in case of impaired consciousness. The solution is administered in portions of 150-200 ml every 5 minutes. After the administration of 1.5-2.5 liters of solution, loose stool appears, followed by watery discharge without inclusions (intestinat). If there is no stool, after the administration of 2.5 liters of solution, a single dose of the solution is halved, an enema is made with the same solution in a volume of about 1.5 liters (25-30 ml per 1 kg of body weight) and / or an injection of an antispasmodic (single dose of papaverine, drotaverine, platifillin and other drugs, excluding atropine). Probiotics and pectin are added to the last portion of the solution in a daily dose. The total volume of the solution is 70-80 ml per 1 kg of the patient's body weight. Monitoring of the body's water balance is carried out by measuring the patient's body weight using floor bed scales before, during and after intestinal lavage, as well as by recording the amount of fluid introduced and excreted by the patient and by the state of laboratory homeostasis indicators.
Intestinal lavage is considered the most effective method of cleansing the intestines in acute oral poisoning, and its use in combination with blood purification methods provides the fastest and most lasting detoxification effect.