Abdominal adhesions are bands of tissue that form between abdominal tissues and organs. these vary from a consistency of wet tissue paper, which are of little significance, to a strong, fibrous band that can readily cause obstruction.
Normally, internal tissues and organs have slippery surfaces, which allow them to shift easily as the body moves. Adhesions cause tissues and organs to stick together.
The intestines are part of the digestive system. Abdominal adhesions can cause an intestinal obstruction.
Although most adhesions cause no symptoms or problems, others cause chronic abdominal or pelvic pain. Adhesions are also a major cause of intestinal obstruction and female infertility.
In most people, abdominal adhesions do not cause any symptoms. Adhesions that partially block the intestine from time to time can cause intermittent bouts of crampy abdominal pain.
More significant intestinal obstruction can cause the following symptoms:
What causes abdominal adhesions?
Abdominal surgery is the most frequent cause of abdominal adhesions. Almost everyone who undergoes abdominal surgery develops adhesions; however, the risk is greater after operations on the lower abdomen and pelvis, including bowel and gynecological surgeries.
Adhesions can become larger and tighter as time passes, causing problems years after surgery.
Surgery-induced causes of abdominal adhesions include
- tissue incisions, especially those involving internal organs
- the handling of internal organs
- the drying out of internal organs and tissues
- contact of internal tissues with foreign materials, such as gauze, surgical gloves, and stitches
- blood or blood clots that were not rinsed out during surgery
A less common cause of abdominal adhesions is inflammation from sources not related to surgery, including
- appendicitis – in particular, appendix rupture
- radiation treatment for cancer
- gynecological infections
- abdominal infections
- Rarely, abdominal adhesions form without apparent cause.
- 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 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.
7In some people 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.
During this operation a surgeon uses instruments to clip the fibers that have formed into adhesions and to remove as much of this scar tissue as possible.
There is no way for you to prevent adhesions. This problem is one reason that doctors are cautious to recommend abdominal surgery only when it is necessary.
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.
When To Call A Professional
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% to 21% of cases.