What is it? Abdominal adhesions are bands of fibrous scar tissue that form on the abdominal organs, causing the organs to stick to one another or to the abdominal wall. The fibrous scarring of adhesions may be due to the after-effects of peritonitis (an infection of the membrane covering the abdominal organs), or it may follow the mechanical injury of serious abdominal trauma. However, in patients living in developed countries, adhesions most commonly develop after abdominal surgical procedures, where organs are handled by the surgical team and temporarily shifted from their normal positions.
In most patients, post-surgical adhesions are inconsequential and produce no health problems. Their existence is merely an incidental finding on autopsy after a patient's death. In about 3% of post-surgical patients, however, fibrous bands of adhesions interfere with the normal passage of intestinal contents, causing either a full or partial intestinal obstruction. In even fewer cases, a portion of the bowel strangulates -twists around a band of adhesions. This strangulation cuts off the normal blood supply to the twisted bowel, and the affected portion of bowel begins to die. When this happens, the patient must be taken to surgery immediately.
Adhesions are fairly rare in patients who have never had abdominal surgery. Among those who have had only one abdominal surgical procedure, adhesions occur postoperatively in 67%-81% of cases. Among those who have had multiple abdominal surgeries, at least 93% develop adhesions.
Symptoms In most patients, abdominal adhesions produce no symptoms. However, if adhesions cause partial, transient intestinal obstruction, the patient may have intermittent bouts of crampy abdominal pain.
When more significant intestinal obstruction develops, the patient may have the following symptoms:
** Severe, crampy abdominal pain - If the obstruction is in the small intestine, pain may localize around or above the navel. If the obstruction involves the large intestine, abdominal pain may concentrate below the navel.
** Vomiting - This may produce either clear stomach juices, or foul-smelling intestinal juices.
** Diarrhea - This is most likely to occur early in the obstruction process.
** Absent or infrequent bowel movements
** Signs of dehydration - These include dry skin, dry mouth and tongue, severe thirst, and infrequent urination.
When strangulation occurs, the patient looks very ill. They have severe, constant abdominal pain, together with other symptoms of obstruction, plus a fever and a rapid heartbeat.
What your doctor looks for Your doctor will look for symptoms of obstruction or strangulation. He or she will also ask you about any surgical procedures you've had, or any episodes of peritonitis or severe abdominal trauma.
Diagnosis Your doctor will suspect the diagnosis of intestinal obstruction or strangulation based on your symptoms and your surgical history, together with the results of your physical examination. In addition to the standard physical exam, with special attention to your abdomen, your doctor will also perform a rectal examination and (in women) 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 is only confirmed at the time of abdominal surgery.
Expected duration Abdominal adhesions are permanent, unless the patient undergoes adhesiolysis (a surgical procedure to break up adhesions).
Prevention Patients cannot prevent adhesions. If you are undergoing abdominal surgery, your surgeon can minimize the risk for adhesions by using a gentle surgical technique, powder-free gloves, and (in some cases) FDA-approved absorbable "adhesion barriers" to protect tissue.
Treatment When adhesions produce intestinal strangulation or significant intestinal obstruction, abdominal surgery is required.
When to call your doctor Call your doctor whenever you have severe abdominal pain, especially if you also have a fever, nausea and vomiting, or infrequent bowel movements.
Prognosis Once abdominal adhesions have formed, even adhesiolysis surgery may not cure the problem. For example, when surgery is performed to remove an intestinal obstruction caused by adhesions, adhesions re-form and create a new obstruction in 11%-21% of cases.
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