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What is Abdominal Adhesion: Causes, Symptoms, Diagnosis, and Treatment

Definition and Overview

Abdominal adhesion is a medical condition in which bands of scar-like tissue cause internal organs (most commonly the bowels) to stick to one another or to the wall of the abdomen, preventing them from moving freely. The condition is a common complication of abdominal surgery, occurring more than 90% of the time. However, not all cases pose a serious medical threat or produce worrying symptoms. In fact, many patients do not even require treatment.

The majority of abdominal adhesions form a few days after surgery. They are mostly asymptomatic until they restrict the bowels (usually the small intestine), which can occur months or even years after surgery. If the intestine has been partially or completely blocked, immediate treatment is necessary so the blood supply to the site after the blockage will not be cut off. The blockage can also cause food, fluid, gas, and gastric acids to build up and cause the intestine to rupture. When this happens, bacteria and harmful intestinal contents will leak into the abdominal cavity.

Although surgery is the only way to free up adhesions, doctors try to manage the condition with conservative treatment as much as possible because surgery can lead to more adhesions.

Causes of Condition

Surgery of the abdomen is the main reason why abdominal adhesions form. The risk is higher in patients who undergo traditional open surgery, which involves making a large incision in the abdominal wall. Adhesions are slightly less likely to occur following a laparoscopic surgery, a minimally invasive method that uses several but significantly smaller incisions.

When people undergo surgery, their immune system responds in an attempt to repair the damage caused by the procedure and the reason why it had to be done. This immune response results in inflammation and the production of sticky scar tissue (fibrin matrix). Normally, this process is followed by fibrinolysis or the enzymatic breakdown of the fibrin in blood clots. However, surgery reduces the amount of chemical the body needs for fibrinolysis. Thus, fibrous bands transform into adhesions instead of being dissolved.

The events during surgery that can cause abdominal adhesions include:

  • Contact with foreign bodies, such as gauzes and gloves

  • Dehydration of abdominal organs and tissue

  • Incisional procedures

  • Stale blood not removed during or after surgery

Abdominal adhesions can also develop due to:

  • Appendicitis, or when the appendix ruptures

  • Peritonitis - An infection that spreads to the membrane of the abdominal organs.

  • Gynaecological infections or conditions - These include endometriosis, an inflammatory condition that may also affect the abdomen.

  • Cancer

Key Symptoms

Many people with abdominal adhesions do not experience any symptoms unless there’s intestinal obstruction, which signs include:

  • Nausea

  • Severe abdominal pain or cramping

  • Vomiting

  • Bloating

  • Abdominal swelling

  • Constipation

  • Unable to pass gas

Patients exhibiting the above symptoms should be taken to a hospital emergency room as soon as possible.

Who to See and Types of Treatments Available

Adhesions cannot be detected by imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scan. The most efficient way to diagnose the condition is through exploratory laparotomy in which a surgical incision is made in the abdominal cavity.

However, imaging tests are useful when complications occur. CT scan, x-rays of the abdomen, and barium contrast, for example, can be used to diagnose a bowel obstruction. Other tests include:

  • Endoscopy - A minimally invasive procedure that involves inserting an endoscope in the mouth or through a small cut in the body. An endoscope is a thin, flexible tube with an attached light source and a camera that feeds images of the internal organs to a computer monitor.

  • Hysteroscopy - A procedure that looks into the inside of the uterus.

  • Laparoscopy - A minimally invasive procedure that involves inserting a thin, lighted tube (laparoscope) through a cut in the abdomen to look at the abdominal and female pelvic organs.

  • Hysterosalpingography - An x-ray examination of a woman’s fallopian tubes and uterus that uses fluoroscopy and a contrast material.

Treatment

Surgery that removes abdominal adhesions is the definitive treatment for the condition. However, it is not recommended if the patient is asymptomatic because surgery can cause more adhesions to form.

Surgery is performed right away if adhesions have caused intestinal obstruction. The goal of the procedure is to restore normal blood flow to the affected part of the intestine and avoid tissue death (necrosis).

Surgery involves removing the obstruction to allow food, fluid, and gastric juices that have accumulated behind the blockage to pass through as normal. It may also involve removing the section of the intestine that has been severely damaged or has died.

If surgery is too risky, such as in cases where a patient is suffering from other medical conditions, an alternate treatment that involves the use of a stent can be recommended. For this procedure, an endoscope is passed through the mouth and guided through the digestive tract to place a self-expanding metal stent in the affected bowel. The stent is designed to expand the walls of the intestine and clear the obstruction. This option is a temporary measure used to relieve the patient’s symptoms. Once their condition has stabilised or improved, they will be prepped for surgery.

Meanwhile, patients whose bowels are only partially blocked can avoid surgery in some cases. Their symptoms can be relieved with a liquid or low-fiber diet, which is more easily broken down into smaller particles by the digestive system.

References:

  • Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91–111.

  • Feldman M, et al. Intestinal obstruction. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com.

  • Munireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. Surg Clin N Am . 2010;90:1227–1236

  • Kulaylat MN, Dayton, MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL,eds. Sabiston Textbook of Surgery . 18th ed.Philadelphia, Pa: Saunders Elsevier; 2007:chap 15.