Abdominal Adhesions - An Overview

Introduction:

Abdominal adhesions are scar-like bands of tissue formed inside the abdomen. These bands are present between two or more organs or between organs and the abdominal wall. Generally, the surfaces of the abdominal wall and organs do not stick during movements. However, abdominal adhesion causes stickiness between the two surfaces. It can cause symptoms like intestinal obstruction by twisting, pulling, or compressing the intestines and other abdominal organs. The most common cause of abdominal adhesion is abdominal surgery. The adhesion can be released with laparoscopic or open surgery. The common symptoms are bloating, constipation and nausea, and vomiting.

What Are the Causes of Abdominal Adhesions?

Laparoscopic surgery is a surgery of the abdomen in which surgeons make a small cut and insert special tools to observe, remove or repair organs and tissues. In contrast, open surgery cases make a large cut in the abdomen. Laparoscopy or open surgeries often lead to abdominal adhesion. Out of 10 or 9 people who underwent laparotomy or open surgery developed abdominal adhesions. However, most people with abdominal adhesion do not develop symptoms and complications.

Following are some conditions that involve infection or inflammation of the abdomen and can potentially lead to abdominal adhesion:

Crohn’s Disease: Is a chronic, prolonged inflammation and irritation of the digestive tract. The symptoms are diarrhea, weight loss, abdominal pain, and cramps.

Endometriosis: It is a disease characterized by tissue growth similar to the endometrium in different body places. These patches of tissue are called lesions, implants, or nodules. They can overgrow on or under the ovaries, on the bladder or bowels, behind the uterus, and on the fallopian tube.

Pelvic Inflammatory Disease: The inflammation and infection of female reproductive organs such as the uterus, ovaries, and other parts. It causes scarring in these organs and leads to infertility, pelvic pain, abscesses, ectopic pregnancy, and other serious issues.

Diverticular Disease: Formation of small sacs or pouches through the weak spots in the colon's wall. It can cause inflammation and bleeding.

Peritonitis: Inflammation of the inner lining of the abdomen wall is known as peritonitis.

Radiation Therapy: It helps to treat different types of abdominal cancers.

Peritoneal Dialysis: The procedure is used to filter blood inside the abdomen or on its lining for the treatment of kidney failure.

In a few rare cases, abdominal adhesion could be present since birth.

What Are the Symptoms of Abdominal Adhesion?

The most obvious symptom of abdominal adhesion is chronic abdominal pain. It can cause intestinal obstruction, which can be severe and lethal.

The symptoms of intestinal obstruction are:

• Bloating: Feeling of fullness or tightness in the abdomen, commonly due to gas.

• Abdominal pain.

• Nausea and vomiting.

• Constipation: Difficulty in normal stool passing.

If the intestinal obstruction ceases the blood flow to the blocked part of the intestine or leads to peritonitis, additional symptoms like increased heart rate or fever may occur.

What Are the Complications Caused by Abdominal Adhesion?

There are two major complications caused due to abdominal adhesion:

Infertility in Females: In women, cases of abdominal adhesion affecting the pelvis region or inside the uterus can compress or obstruct the parts of the reproductive system and cause infertility.

Intestinal Obstruction: Obstruction in the movement of food, air, fluids, and waste material (stool) through the intestine is known as intestinal obstruction. It can be partial or complete. Abdominal adhesion is one of the common reasons behind this obstruction.

Intestinal obstruction leads to:

• Inflammation and infection in the lining of the abdomen (peritoneum).

• The deficiency of blood in the blocked intestine region causes intestinal tissue death.

How to Diagnose Abdominal Adhesion?

• Medical History: A thorough medical history is taken of any abdominal surgery or any other cause of abdominal adhesion. History of any disease or disorder showing similar symptoms like abdominal adhesion is also necessary.

• Physical Examination: It is necessary to check any tenderness or pain in the abdomen on palpation (tapping).

• Blood Tests: Though blood tests do not help to investigate abdominal adhesion, it is helpful to rule out other diseases similar to adhesion. It can be helpful in evaluating the nature of obstruction in cases of intestinal obstruction.

• Imaging Tests: These tests can help to investigate intestinal obstruction.

• X-rays.

• Computed Tomography Scan: It is a combination of X-rays and computers to create images that can help to observe and evaluate the site, severity, and cause of intestinal obstruction.

• Water-Soluble Contrast Medium: A special liquid that helps to make the digestive tract more visible on X-rays is used to know if the cause of intestinal obstruction is abdominal adhesion. This medium also helps to relieve the obstruction.

• Laparoscopy and Open Surgery: In some cases, it can be advised to look inside the abdomen by making a small or large incision. These surgeries can also help to remove the cause.

What Are the Treatment Options for Abdominal Adhesion?

• In the case of asymptomatic abdominal adhesion, no treatment is necessary.

• In cases where symptoms are present, surgeries such as laparoscopy or open surgery can be performed. However, these surgeries can again lead to new abdominal adhesion.

• In the cases of abdominal adhesion with intestinal obstruction, surgeries are done to relieve the obstruction depending upon its severity and location.

• If the cases are not severe, it is advisable to treat the obstruction without surgery. Intravenous fluids are given through a nasal tube into the stomach, which helps to remove the food content in the track and relieve the obstruction.

How to Prevent Abdominal Obstruction?

Preventive measures can be taken by medical professionals and surgeons during abdominal surgery:

• Laparoscopy should be suggested instead of open surgery in possible cases.

• Handling the tissue delicately can prevent damage.

• Proper precautions are taken to avoid foreign materials in the abdomen. This can be done by using lint-free tools and powder-free gloves.

• An absorbable film-like barrier is placed inside the abdomen after the surgery, which helps to keep the tissue separated while healing.

Conclusion:

Abdominal adhesion is a disorder due to abdominal surgeries mainly. The sticking of walls of organs with each other or the walls of organs and the abdominal lining is known as abdominal adhesion. It can cause problems such as intestinal obstruction, which can be severe in nature and cause multiple problems. The treatment for abdominal adhesion is releasing adhesive walls and removal of intestinal obstruction if any present.