Whole bowel irrigation
Whole bowel irrigation (WBI) is a medical process involving the rapid administration of large volumes of an
History
Whole bowel irrigation was originally developed to cleanse the large bowel before
Indications
Whole bowel irrigation is sometimes used prior to colonoscopy, bowel surgery, other abdominal/pelvic surgery, or a
Whole bowel irrigation is also used in certain poisoning situations. It is usually reserved for patients who have ingested toxic doses of medications not absorbed by
Technique
Whole bowel irrigation is undertaken either by having the patient drink the solution or a
When used as treatment for poisoning, the procedure is usually performed in a healthcare facility, and normally continues until the
Vomiting is a common side effect of the macrogol solutions used for WBI, which may hinder the effectiveness of the procedure for any indication. In cases of poisoning, the presence of vomiting prior to the procedure is not uncommon. It may be the result of administration of ipecac prior to the procedure, and/or a symptom of the poisoning itself. Overdoses of such drugs as aspirin and theophylline are likely to result in vomiting. Whenever vomiting occurs before or during WBI, the rate of the procedure may need to be slowed, alternatives considered, or an antiemetic such as metoclopramide administered.
Contraindications
Major gastrointestinal dysfunction precludes the use of whole bowel irrigation. WBI is specifically
Complications
Minor complications include nausea, vomiting, abdominal cramps, and bloating.[6] Patients with altered mental status or a compromised and unprotected airway are at risk for pulmonary aspiration.[4]
Alternatives
Several other laxatives are available for cleansing of the bowels prior to colonoscopy, surgery, or other procedures. Studies have shown some of these to be comparable to macrogol solutions in terms of effectiveness and better tolerated by patients due to the lower volume of laxative which must be ingested. Enemas are another option.
Alternatives to WBI in cases of poisoning may include