Irrigation (a2083)

IRRIGATION (irrigation), was widely used in the past for female diseases and in obstetrics as one of the methods for protecting the surgical field from infection (the so-called "wet" method of laparotomy), as well as for cleaning purulent wounds and especially purulent cavities, including the postpartum uterus. At present, the use of irrigation has been greatly restricted and is only used by some for irrigating the postpartum uterus in cases of atony, when infection is suspected after intrauterine operations (version, manual separation after delivery), and for postpartum endometritis. Instead, irrigation is widely used for diseases of the female genital tract in the form of so-called douches (vaginal). For this purpose, an ordinary Esmarch's syringe, a rubber tube, and special vaginal nozzles are used. When using douches, the therapeutic effect is achieved either by the temperature's effect on the vagina, uterus, and surrounding tissues, or by the mechanical removal of discharge, as well as the disinfecting effect of the liquid, for which antiseptic and astringent substances are added to the water. Besides the usual short-term douches, which use 1-2 liters of liquid, long-term vaginal irrigations are also used for therapeutic purposes, for which a special apparatus in the form of a glass flask or pear is used. Through such a pear, which hermetically seals the entrance to the vagina, two tubes are passed: one inlet and one outlet. With this apparatus, many liters of medicinal solution can be passed through the vagina, and the pressure in the vagina is somewhat increased, due to which the vagina is stretched, its folds are straightened, and the antiseptic liquid penetrates into all "corners." Besides hospital and home settings, vaginal irrigation is also used as a balneological procedure at resorts (e.g., in Matsesta). Somewhat separate as a special method for treating acute inflammatory diseases of the uterus stands the so-called constant irrigation, proposed by V. F. Snegirev. This method apparently developed from the constant irrigation of the uterus proposed in 1877 by Schücking. Schücking inserted two metal tubes (catheters) wrapped in gauze into the postpartum uterus and passed an antiseptic liquid through the uterine cavity. The flow of liquid could be regulated with a tap or such an apparatus as is now used for drop enemas. In this form, constant uterine irrigation was carried out for many hours and even days, changing the tubes and gauze every 12 hours. Subsequently, this method of constant uterine irrigation was modified in various directions: thus, the most diverse antiseptic solutions were proposed, moreover of different strengths; different temperatures - from icy to hot (50°); different duration of application, and finally the technique of application. In the latter respect, mention should be made of a number of intrauterine nozzles with double current (a double courant), or more accurately "with ensured outflow." Of such nozzles, the most well-known is the Fritsch-Bozmena nozzle (see Obstetrical Instrumentarium, Table III, Fig. 39). The use of constant uterine irrigation in the above-described form initially found numerous supporters as the "ideal Listerization of the postpartum uterus," but soon the negative sides of this treatment method were discovered - the prolonged leaving of a metal nozzle in the uterine cavity traumatized the delicate regenerating mucosa and destroyed the protective granulation barrier. To avoid this negative side of constant uterine irrigation, Snegirev began to use constant vaginal irrigation, using a special nozzle invented by P. O. Morozov. This nozzle, inserted into the vagina, adheres to its walls and thus hermetically separates the upper part of the vagina and the uterine cavity from the external environment. The liquid passed through the nozzle, besides its thermal and antiseptic effect, also produces a suction effect, due to which the contents of the uterus are removed. Moreover, constant irrigation causes intense hyperemia in the pelvic area, and thus the idea of Vir about treating inflammatory processes with hyperemia was anticipated here. (A detailed exposition of the technique of constant irrigation and its indications can be found in the book "Uterine Bleeding" by V. F. Snegirev.) At present, constant irrigation is rarely used and almost exclusively for postpartum and post-abortion endometritis, especially those developing on the basis of retention of membranes and parts of the placenta. When the inflammatory process spreads beyond the uterus, constant irrigation becomes dangerous, as it promotes further spread of the process. In metrotrombophlebitis, constant irrigation is contraindicated due to the danger of generalization of the process by means of emboli. In sepsis, already generalized, constant irrigation is useless.