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.

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.

Symptoms

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.