Abdominal adhesions

What are abdominal adhesions?

Abdominal adhesions are bands of fibrous scar tissue that form on organs in the abdomen. They can cause organs to stick to one another or to the wall of the abdomen.

Abdominal adhesions most commonly develop after surgery. Abdominal organs handled by the surgical team are shifted temporarily from their normal positions. In some people, this stimulates excessive formation of scar tissue.

Adhesions can also form in people who develop peritonitis, an infection that has spread to the membrane that covers the abdominal organs. Another unusual cause is endometriosis. Tissue that normally lines only the uterus grows in other parts of the body, such as inside the abdomen.

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 intestines either completely or partially. This blockage is called a bowel obstruction.

Sometimes, an area of intestine that is affected by adhesions can keep becoming blocked then unblocked, causing symptoms to come and go.

Rarely, a portion of the bowel twists tightly around a band of adhesions. This cuts off the normal blood supply to the twisted bowel, causing what is called "strangulation," and that section of bowel begins to die. When this emergency happens, the person must be taken to surgery immediately.

Adhesions are fairly rare in patients who have never had abdominal surgery. In people who have had multiple abdominal surgeries, adhesions are common.

Symptoms of abdominal adhesions

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:

• 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.

Diagnosing abdominal adhesions

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 likely order blood tests and an abdominal CT scan. In some people with suspected intestinal obstruction or strangulation, the diagnosis can be confirmed only at the time of abdominal surgery.

Expected duration of abdominal adhesions

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.

Preventing abdominal adhesions

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.

Treating abdominal adhesions

Complete small bowel obstructions that are caused by adhesions often require surgery. 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) and give the person a chance to avoid surgery.  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.

Prognosis

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 tend to form again and create a new obstruction.

Additional info

National Digestive Diseases Information Clearinghouse
https://www.niddk.nih.gov/