Abdominal Adhesions

What are abdominal adhesions?

Abdominal adhesions are bands of tissue that form between abdominal tissues and organs. 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.



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.

Abdominal Adhesions Overview

An adhesion is a band of scar tissue that binds 2 parts of your tissue together. They should remain separate. Adhesions may appear as thin sheets of tissue similar to plastic wrap or as thick fibrous bands.

The tissue develops when the body's repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation. Although adhesions can occur anywhere, the most common locations are within the stomach, the pelvis, and the heart.

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.

How can abdominal adhesions cause intestinal obstruction?

Abdominal adhesions can kink, twist, or pull the intestines out of place, causing an intestinal obstruction. An intestinal obstruction partially or completely restricts the movement of food or stool through the intestines. A complete intestinal obstruction is life threatening and requires immediate medical attention and often surgery.

What are the symptoms of abdominal adhesions?

Although most abdominal adhesions go unnoticed, the most common symptom is chronic abdominal or pelvic pain. The pain often mimics that of other conditions, including appendicitis, endometriosis, and diverticulitis.

What are the symptoms of an intestinal obstruction?

Symptoms of an intestinal obstruction include

* severe abdominal pain or cramping
* vomiting
* bloating
* loud bowel sounds
* swelling of the abdomen
* inability to pass gas
* constipation

A person with these symptoms should seek medical attention immediately.

How are abdominal adhesions and intestinal obstructions diagnosed?

No tests are available to diagnose adhesions, and adhesions cannot be seen through imaging techniques such as x rays or ultrasound. Most adhesions are found during exploratory surgery. An intestinal obstruction, however, can be seen through abdominal x rays, barium contrast studies—also called a lower GI series—and computerized tomography.

How are abdominal adhesions and intestinal obstructions treated?

Treatment for abdominal adhesions is usually not necessary, as most do not cause problems. Surgery is currently the only way to break adhesions that cause pain, intestinal obstruction, or fertility problems. More surgery, however, carries the risk of additional adhesions and is avoided when possible.

A complete intestinal obstruction usually requires immediate surgery. A partial obstruction can sometimes be relieved with a liquid or low-residue diet. A low-residue diet is high in dairy products, low in fiber, and more easily broken down into smaller particles by the digestive system.

Can abdominal adhesions be prevented?

Abdominal adhesions are difficult to prevent; however, surgical technique can minimize adhesions.

Laparoscopic surgery avoids opening up the abdomen with a large incision. Instead, the abdomen is inflated with gas while special surgical tools and a video camera are threaded through a few, small abdominal incisions. Inflating the abdomen gives the surgeon room to operate.

If a large abdominal incision is required, a special filmlike material (Seprafilm) can be inserted between organs or between the organs and the abdominal incision at the end of surgery. The filmlike material, which looks similar to wax paper, is absorbed by the body in about a week.

Other steps during surgery to reduce adhesion formation include using starch- and latex-free gloves, handling tissues and organs gently, shortening surgery time, and not allowing tissues to dry out.

Points to Remember

* Abdominal adhesions are bands of tissue that form between abdominal tissues and organs, causing tissues and organs to stick together.
* Although most adhesions cause no symptoms or problems, others cause chronic abdominal or pelvic pain, bowel obstruction, or female infertility.
* Abdominal surgery is the most frequent cause of abdominal adhesions.
* Abdominal adhesions can kink, twist, or pull the intestines out of place, causing an intestinal obstruction.
* A complete intestinal obstruction is life threatening and requires immediate medical attention and often surgery.
* Abdominal adhesions cause female infertility by preventing fertilized eggs from reaching the uterus, where fetal development takes place.
* No tests are available to diagnose adhesions, and adhesions cannot be seen through imaging techniques such as x rays or ultrasound.
* An intestinal obstruction can be seen through abdominal x rays, barium contrast studies—also called a lower GI series—and computerized tomography.
* Surgery is currently the only way to break adhesions that cause pain, intestinal obstruction, or fertility problems.



General Facts

* Abdominal adhesions: Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery. Abdominal adhesions also occur in 10.4% of people who have never had surgery.

o Most adhesions are painless and do not cause complications. However, adhesions cause 60%-70% of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.

o Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years. As scar tissue begins to restrict motion of the small intestines, passing food through the digestive system becomes progressively more difficult. The bowel may become blocked.

o In extreme cases, adhesions may form fibrous bands around a segment of an intestine. This constricts blood flow and leads to tissue death.