Abdominal Adhesions

What Is It?

Abdominal adhesions are bands of fibrous scar tissue that form on abdominal organs, causing the organs to stick to one another or to the wall of the abdomen. In people living in developed countries, adhesions most commonly develop after abdominal surgery, in which organs are handled by the surgical team and are shifted temporarily from their normal positions. Similar scarring can occur in people who develop peritonitis, the spread of an abdominal infection to the membrane that covers the abdominal organs. Peritonitis can occur after appendicitis or another abdominal infection. Other causes of adhesions include endometriosis, an inflammatory condition that affects some women and may involve the abdomen and serious abdominal trauma.

What Is It? Symptoms Diagnosis Expected Duration Prevention

Treatment When To Call A Professional Prognosis

In most patients, adhesions do not cause health problems. In a small number of people who have adhesions, however, the fibrous bands of scar tissue block the flow of material through the intestines either completely or partially. This blockage is called an intestinal obstruction, and it leads to death in about 5 percent of cases. Sometimes, an area of intestine that is affected by adhesions can repeatedly become blocked then reopen, causing symptoms of obstruction off and on. In about 10 percent of small-bowel obstructions, a portion of the bowel twists tightly and persistently around a band of adhesions. This tight twisting cuts off the normal blood supply to the twisted bowel, causing “strangulation,” and that section of bowel begins to die. When this emergency happens, the person must be taken to surgery immediately. The death rate is as high as 37 percent in people who develop strangulation.

Adhesions are fairly rare in patients who have never had abdominal surgery. In people who have had multiple abdominal surgeries, adhesions are common.

In most people, abdominal adhesions do not cause any symptoms. However, if adhesions cause partial intestinal obstruction that comes and goes, the person may have intermittent bouts of crampy abdominal pain.

When more significant intestinal obstruction develops, the following symptoms can occur:

• Severe, crampy abdominal pain
• Nausea and vomiting
• Swelling of the abdomen (abdominal distension)
• Inability to pass gas and absent or infrequent bowel movements
• Signs of dehydration, including dry skin, dry mouth and tongue, severe thirst, infrequent urination, fast heart rate and low blood pressure

If the bowel becomes strangulated, people typically develop severe abdominal pain, which can be either crampy or constant. The abdomen is distended and tender when touched even lightly. People with a strangulated bowel usually also develop signs of systemic (body-wide) illness, such as fever, fast heart rate and low blood pressure.

Your doctor will suspect intestinal obstruction or strangulation based on your symptoms and your history of surgery, together with the results of a physical examination. Your doctor will examine you, paying special attention to your abdomen. He or she also will examine your rectum. If you are a woman, your doctor will do a pelvic exam. To find further evidence for the diagnosis, your doctor will order blood tests and X-rays of your chest and abdomen. In some patients with suspected intestinal obstruction or strangulation, the diagnosis can be confirmed only at the time of abdominal surgery.

Abdominal adhesions are permanent unless the patient has a surgical procedure, called adhesion lysis, that breaks up adhesions.

There is no way for you to prevent adhesions. If you are having abdominal surgery, your surgeon can minimize the risk of adhesions by using a gentle surgical technique and powder-free gloves.

Small-bowel obstructions that are caused by adhesions require surgery in almost every case. In cases of partial bowel obstruction or complete bowel obstruction without severe symptoms, surgery may be delayed for 12 to 24 hours to allow a dehydrated patient to receive fluids intravenously (into a vein) prior to the operation. In this case, a small suction tube that extends through the nose and into the stomach can be used to prevent additional bloating and to relieve pain and nausea. When adhesions cause intestinal strangulation, immediate abdominal surgery is required to remove the adhesions so that blood flow to the bowel can be restored.

Call your doctor whenever you have severe abdominal pain, especially if you also have a fever, nausea and vomiting, or infrequent bowel movements.

Abdominal adhesions can be treated, but they can be a recurring problem. Because surgery is both the cause and the treatment, the problem can keep returning. For example, when surgery is done to remove an intestinal obstruction caused by adhesions, adhesions form again and create a new obstruction in 11 percent to 21 percent of cases.

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