Patient Basics: Abdominal Adhesions

Originally published by Harvard Health.

What Is It?

Abdominal adhesions are bands of fibrous scar tissue that form on organs in the abdomen, causing the organs to stick to one another or to the wall of the abdomen. In people living in developed countries, this scar tissue most commonly develops after abdominal surgery, in which organs are handled by the surgical team and are shifted temporarily from their normal positions. It can also form in people who develop peritonitis, an infection that has spread to the membrane that covers the abdominal organs. Peritonitis commonly occurs after appendicitis or another abdominal infection. Another cause of adhesions is endometriosis, an inflammatory condition that affects some women and may involve the abdomen and serious abdominal trauma.

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, and it leads to death in about 5% of cases. Sometimes, an area of intestine that is affected by adhesions can keep becoming blocked then unblocked, causing symptoms to come and go. In about 10% of small bowel obstructions, 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. The death rate is as high as 37% in people who develop strangulation.

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

Symptoms

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.

Diagnosis

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 order blood tests and X-rays of your chest and abdomen. In some people with suspected intestinal obstruction or strangulation, the diagnosis can be confirmed only at the time of abdominal surgery.

Expected Duration

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.

Prevention

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.

Treatment

Small bowel obstructions that are caused by adhesions require surgery in almost every case. 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) prior to the operation. 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 form again and create a new obstruction in 11% to 21% of cases.

Additional Info

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Toll-Free: (800) 891-5389
Phone: (301) 654-3810
Fax: (301) 907-8906
http://digestive.niddk.nih.gov/