Adhesions are bands of scar tissue that form internally, usually within the abdominal cavity, following inflammation or injury. They cause organs and tissues that are normally separate and mobile to stick together. These fibrous bands are a common consequence of abdominal or pelvic surgery, especially after an open procedure. While many people live without symptoms, these internal attachments can tether organs, sometimes leading to complications requiring medical attention.
Understanding Abdominal Adhesions
Abdominal adhesions form inside the body, usually within the peritoneum. The most frequent cause is previous surgery, where the body’s repair mechanism responds to trauma by generating scar tissue. This process can result in organs, such as the small intestine, becoming attached to each other or to the abdominal wall.
Other sources of inflammation or injury can also trigger adhesion formation, including infections like appendicitis, peritonitis, or pelvic inflammatory disease (PID). Endometriosis and radiation therapy for cancer are also recognized causes. Adhesions can create kinks or twists in the intestine, restricting the normal movement of contents through the digestive tract. This mechanical interference can cause symptoms ranging from chronic abdominal pain to a life-threatening intestinal blockage.
CT Scan Efficacy in Diagnosis
A computed tomography (CT) scan is often used for patients with symptoms suggestive of adhesions, such as severe abdominal pain or vomiting. However, the CT scan generally cannot directly visualize the adhesions themselves. The primary utility of the CT scan is detecting the consequences of adhesions, specifically a small bowel obstruction (SBO), which is the most common serious complication.
When a small bowel obstruction is present, the CT scan provides clear evidence of the blockage. Radiologists look for dilated loops of the small intestine proximal to the obstruction, which appear swollen. This is contrasted with collapsed bowel loops distal to the blockage. The most telling sign is the “transition point,” where the bowel abruptly changes from a dilated segment to a collapsed one.
This abrupt transition, especially when no other cause like a tumor or hernia is visible, is often the only hint that an adhesion is tethering the bowel and causing the obstruction. The use of oral and intravenous contrast material enhances the visualization of the bowel wall and surrounding anatomy, allowing for a better assessment of the blockage. While CT is highly effective for confirming SBO, identifying the adhesion itself remains a diagnosis of exclusion.
Alternative Diagnostic Methods
When the diagnosis is uncertain or non-obstructing adhesions are suspected, other methods are employed. Magnetic Resonance Imaging (MRI) offers superior soft-tissue contrast compared to CT. Specialized techniques, like cine-MRI, can track organ movement in real-time, potentially revealing restricted motion indicative of an adhesion. However, MRI has limitations and may occasionally overestimate the presence of these bands.
Another non-invasive approach involves specialized X-ray studies, such as a small bowel follow-through or enteroclysis. A contrast agent is swallowed and tracked, which can sometimes show indirect signs of adhesions, such as a band-like impression or abnormal kinking. Ultimately, the most definitive method for diagnosis is exploratory surgery, known as diagnostic laparoscopy. This minimally invasive procedure involves inserting a camera to directly visualize the abdominal cavity and confirm the presence and extent of the fibrous bands.
Management and Treatment Options
The approach to managing abdominal adhesions is determined by whether they are causing symptoms. Adhesions discovered incidentally that cause no problems typically do not require treatment. For patients presenting with a partial or subacute small bowel obstruction, a non-surgical management strategy is often attempted first.
This conservative approach involves bowel rest, along with fluid and electrolyte replacement to correct imbalances. A nasogastric tube may be placed through the nose into the stomach for bowel decompression, helping to relieve pressure. If the obstruction does not resolve with conservative measures, or if there are signs of bowel compromise like a complete blockage or tissue death, surgical intervention becomes necessary.
The surgical procedure to cut or separate the adhesions is called adhesiolysis. It can be performed through either a traditional open surgery (laparotomy) or a minimally invasive procedure (laparoscopy). Surgeons may also place anti-adhesion barriers during the procedure. These barriers are designed to dissolve and physically separate tissues to help prevent new scar tissue from forming post-operatively.