| Abdominal adhesions are bands of scar tissue that have formed inside the abdomen. The adhesions can form between the inside of the abdominal wall and the small intestine (the omentum), between loops of small intestine, or between any of the abdominal organs.
Abdominal adhesions may form in response to surgery, bleeding, or an inflammatory disease in the abdomen. Adhesions are the most common cause of bowel obstruction, particularly in the small bowel, because the intestine wraps itself around the adhesion, blocking a portion of the bowel. In women, they may form on or adhere to the ovaries and fallopian tubes (pelvic adhesions), resulting in obstruction of reproductive functions and often lead to infertility. Adhesions can also result in blockage of blood flow to parts of the bowel, called strangulation, which requires immediate surgical treatment.
Adhesions can result from endometriosis, perforated ulcers, appendicitis, or infections in the fallopian tubes. Other causes of adhesions include radiation treatment to the abdomen or a foreign substance or object left in the abdomen after surgery. Any trauma to the abdomen may result in adhesions. Adhesion formation remains a major complication after lower abdominal and gynecologic operations. Although more of these procedures are now being done through use of a small incision and a scope (laparoscopy), the rate of adhesion formation has not significantly decreased.Risk: Although abdominal adhesions most commonly occur following abdominal or pelvic surgery; they can also occur in those who have never had surgery. The incidence of abdominal adhesions is reported to range from 55% to 94% of individuals who have had either abdominal or pelvic surgery (Diamond). Alternatively, abdominal adhesions occur about 10% of the time in those who have never had surgery (Hardin). Incidence and Prevalence: The number of abdominal adhesions requiring surgical correction (adhesiolysis or lysis of adhesions) in the US is 400,000 individuals a year (Weisman). |
Source: Medical Disability Advisor
| History: Individuals usually report prior abdominal surgery, particularly if a postoperative infection developed. Cramping and intense abdominal pain are the primary symptoms of adhesions that are causing partial intestinal obstruction. Nausea followed by vomiting that may occur in waves is also reported if the adhesion causes complete intestinal obstruction. Physical exam: The exam may reveal a surgical scar. Abdominal distention may be seen if complete intestinal obstruction has occurred. Listening to the abdomen with a stethoscope (auscultation) may reveal abnormal bowel sounds. Tests: Plain abdominal x-rays or contrast films (upper GI or barium enema) may reveal small bowel obstruction. If pain is the only symptom and there is no evidence of intestinal obstruction, many other tests may be done. Visually examining the various areas and levels of the gastrointestinal tract with various scopes (endoscope, colonoscope, sigmoidoscope, proctoscope) can identify adhesions. MRI evaluation may be useful in some cases. In cases where the diagnosis is questionable, surgical exploration and visualization either by laparoscopy or laparotomy may be the final diagnostic test. |
Source: Medical Disability Advisor
| Surgical release of adhesions (adhesiolysis or lysis of adhesions) is the only effective treatment, but it may be problematic since surgery may have been the original cause of adhesions. Adhesiolysis of both abdominal and pelvic adhesions can often be performed through a scope inserted through a small skin incision (laparoscopy). Through the laparoscope or via open surgical procedure, the adhesions will be cut (sharp dissection), electrically coagulated, or laser treated (ablation).
If an area of bowel has had its blood supply cut off, it may be necessary to remove (resect) that portion of intestine. This may necessitate connecting the bowel to the abdominal wall (ostomy), which may be able to be reconnected to bowel at a later time.
Newer surgical techniques have been developed in which membranes made of cellulose, polytetrafluoroethylene (PTFE), or sodium hyaluronate/carboxymethylcellulose (HA/CMC) are inserted between organs during surgery. They reduce the tendency for adhesions to develop. Adhesiolysis of small adhesions in the colon can be performed through a scope (colonoscope, sigmoidoscope). |
Source: Medical Disability Advisor
| Surgical removal of the adhesions produces a good outcome, with full recovery in the majority of individuals. However, in about 11% to 21% of cases, the adhesions will reform within weeks to years after the surgery ("Abdominal Adhesions"). |
Source: Medical Disability Advisor
| More adhesions may develop following the surgery to remove the original adhesions. Bleeding, infection, and mechanical injury may occur as complications after surgery. |
Source: Medical Disability Advisor
| If the individual has had surgical treatment, time off from work to recover from surgery is needed. If sedentary duties are available, the individual may return to work during the latter weeks of recovery, but lifting, pushing, pulling, and climbing activities may not be permitted until postoperative recovery is complete. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- What is the suspected cause of the adhesions? Previous surgery? Bleeding? Inflammatory disease?
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Was radiation treatment to the abdomen performed?
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Does individual have a history of a perforated ulcer, appendicitis, endometriosis, or infections in the fallopian tubes?
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On exam, were there abnormal bowel sounds? Was abdominal distention evident?
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Were plain abdominal x-rays, upper GI, or barium enema done to rule out a bowel obstruction?
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Was endoscopic examination of the GI tract done?
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Was MRI done?
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Was it necessary to do surgical exploration?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Were the adhesions released through the laparoscope or open procedure?
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Were the adhesions cut, electrically coagulated, or laser treated?
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What kind of membrane was used during the current surgery?
Regarding prognosis:
- Does individual have any comorbid conditions that could affect recovery?
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Did adhesions reform?
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Source: Medical Disability Advisor
| "Abdominal Adhesions." InteliHealth. 12 Sep. 2004 <http://www.intelihealth.com/IH/ihtIH/WSIHW000/331/9394.html#prognosis>.Diamond, Michael P. "About Adhesions." Ntero Surgical. 12 Sep. 2004 <http://www.ellisdigital.com/ntero/aboutadh.htm>. Hardin, Eugene, and Christopher R. Westfall. "Adhesions, General and After Surgery." eMedicine Consumer Health. Eds. Scott H. Plantz, Francisco Talavera, and Anthony Anker. 3 Jan. 2005. Medscape. 12 Sep. 2004 <http://www.emedicinehealth.com/articles/13796-1.asp>. Weisman, David M. "A Patient's Guide to Adhesions and Related Pain." ObGyn.Net. MediSpecialty.com, Inc. 12 Sep. 2004 <http://www.obgyn.net/adhesions.asp>. |
Source: Medical Disability Advisor
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