Abdominal adhesions are fibrous scar tissues that adhere to structures present in the abdomen. This includes various organs in the abdominal cavity and the abdominal wall. Normally the tissues and organs in the abdominal cavity slide smoothly against each other due to their slippery surface during movement. Slippery surface prevents them from tethering against each other. The process is known as visceral slide.
Adhesions cause the organs to stick to one another. They form anywhere in the abdominal cavity. The fibrous scars vary in shape and size and they may or may not produce symptoms.
The scar tissue mainly forms after abdominal or pelvic surgery where the surgeon often has to shift the organs for sometime from their normal anatomical position. Infections in abdomen such as appendicitis, peritonitis, tuberculosis of abdomen or inflammatory causes such as endometriosis in women are other common causes of abdominal adhesions.
Usually abdominal adhesions without any symptoms do not require any treatment. However, if symptoms are severe adhesions are required to be removed surgically.
What Are The Causes Of Abdominal Adhesions?
Most people develop adhesions in their abdomen after abdominal surgery. The risk is much more with frequent surgeries, especially intestinal and pelvic organ surgeries. Adhesions can become tight and large in size many years after surgery. During surgery of abdomen, the surgeon has to incise the tissues and organ of the abdomen. He has to handle the organs or temporarily have to shift organs and tissues.
Various materials such as surgical instruments, gauze, gloves and stitches come in contact with internal tissues and organs. Often the tissues and organs have to be dried out; the oozing blood has to be rinsed. All this handling of tissues and organs can be a trigger to cause adhesions.
Adhesions can also develop due to inflammation and infection of the organs of abdomen and pelvis. For example rupture of appendix, tuberculosis of intestine or pelvic organs, radiation treatment for abdominal cancer etc can produce fibrous scars in the abdominal tissues and organs.
Common Symptoms Of Abdominal Adhesions
Most people with adhesion in their abdomen do not produce any symptoms. When the symptoms are present, acute pain in abdomen and pelvis is most common. Pain occurring due to adhesions is often suspected as pain of other conditions such as chronic appendicitis, endometriosis, etc.
Abdominal adhesions can cause complete or partial intestinal obstruction if it twists around the intestine. It restricts passage of intestinal content. Complete obstruction can be life-threatening and requires immediate medical treatment. Adhesions can also cause infertility in women if the adhesion kinks the fallopian tube and prevents passage of egg from reaching the uterus.
Following are the common symptoms of abdominal adhesion causing intestinal obstruction:
- Severe pain in abdomen. Often severe pain is sudden in onset but patient may have mild history of pain since several days.
- Nausea and vomiting.
- Abdominal distension.
- Bowel sound cannot be heard on auscultation with the stethoscope.
- Constipation with passage of jelly like stool laced with blood in some patients.
- Toxic look of the patient with rapid pulse, low blood pressure, cold and clammy hands and feet.
- Patient appears severely sick.
- Abdomen is tender to touch.
Diagnosis And Treatment Of Abdominal Adhesions
Abdominal adhesions are not detected by radiological X-ray or MRI. They are only found when the surgeon opens the abdomen. However, intestinal obstruction can be detected with sonogram, MRI and X-ray. Dysfunctional fallopian tube can be detected with hysteron-salpingography test.
Abdominal adhesions which do not produce any symptoms may not require to be treated. However, if adhesion causes intestinal obstruction, severe and frequent pain in abdomen, infertility problem the only way to solve this issue is surgery.