Abdominal adhesions

What causes it?

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. Other causes of adhesions are abdominal trauma and endometriosis, an inflammatory condition that affects some women and may involve 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 cause the intestines (bowels) to kink or twist either completely or partially leading to bowel obstruction. This necessitates surgery in small number of cases. Sometimes, an area of intestine that is affected by adhesions can keep becoming blocked then unblocked, causing symptoms to come and go. Occasionally, a portion of the bowel twists tightly around a band of adhesions in small bowel obstruction. 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, urgent surgery is often necessitated.

Adhesions are fairly rare in patients who have never had abdominal surgery. In people who have had multiple abdominal surgeries, adhesions are common. At present, there are no effective preventative measures to avoid adhesions.

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.