ABDOMINAL ADHESIONS
Abdominal adhesions are bands of fibrous or scar-like tissue that forms between abdominal tissues and organs, especially after an abdominal surgical procedure.
- Abdominal adhesion begins to form within the first few days after surgery, but symptoms may not appear till after months or even years.
- Normally, internal tissues and organs are made up of slippery surfaces that keep them from sticking together and allow them to shift easily as the body moves.
- However, abdominal adhesions cause tissues and organs in the abdominal cavity to stick together.
- Abdominal adhesions might connect the loops of the intestines to each other, to the wall of the abdomen, or to nearby tissues.
- They can also pull the small and the large intestine out of place, causing an internal obstruction.
- Adhesions are normal surgical outcome, about 93% of people who have abdominal surgery develop an adhesion.
- The risk of abdominal adhesion is greater in people who have had operations on the lower abdomen and pelvis, including bowel and gynecological surgeries.
- Adhesions do not cause any problem, but when they do, they can partly or completely block or obstruct the intestines causing severe abdominal pain.
- Intestinal obstruction requires immediate medical attention.
CAUSES
The most common cause of abdominal adhesion is abdominal surgery. Surgically related causes of abdominal adhesion include:
- Unrinsed blood or blood clots after surgery
- The drying out of internal organs and tissues
- Handling of internal organs
- Contacts of internal tissues with foreign materials such as stitches, gauze, surgical gloves
- Incision of tissues, especially those involving the internal organs
Abdominal adhesions can also form from inflammation not related to surgery such as:
- Radiation treatment for cancer
- Abdominal infections
- Gynaecological infections
- Appendix rupture
SYMPTOMS
The condition does not usually cause any symptoms. Adhesion that causes intestinal obstruction can cause:
- Severe abdominal pain
- Nausea and vomiting
- Abdomen distention (swelling of the abdomen)
- Constipation
- Inability to pass gas
- Bloating
- Loud bowel sounds
- Dehydration symptoms including dry skin, dry mouth, and tongue, infrequent urination, low blood pressure, or severe thirst.
Abdominal adhesion can also cause infertility in women. This happens because the adhesion can prevent fertilized eggs to reach the uterus, where fetal development occurs.
If the abdominal adhesions are in or around the fallopian tubes, there is an increased chance of ectopic pregnancy.
Abdominal adhesions in the uterus can cause repeated miscarriages.
DIAGNOSIS AND TREATMENT
Most abdominal adhesions are found during surgery performed to examine the abdomen.
There are no tests present to clearly identify adhesion, but the pattern of obstruction can be recognized by abdominal x-rays, a lower GI series, and CT scans.
Other tests such as ultrasonography are often necessary to rule out other condition such as tumors that can cause obstruction.
TREATMENT
Some adhesion resolves on their own.
If the abdominal adhesion partly blocks the intestine, a diet low in fiber can allow food to move freely and easily through the area affected.
Complete intestinal obstruction usually requires immediate medical attention. The only treatment option is surgery which can either be laparoscopic or open surgery.
Abdominal adhesion that causes fertility problems can also be treated using surgery.