Intra-abdominal adhesions are bands of scar tissue that form inside the abdomen, causing organs or tissues to stick together. Normally, organs within the abdominal cavity have smooth, slippery surfaces, allowing them to glide freely. Adhesions disrupt this natural movement by creating unwanted connections between these surfaces or between organs and the abdominal wall. These fibrous bands can range from thin, transparent sheets to thick, dense structures.
How and Why They Form
Intra-abdominal adhesions often form as part of the body’s healing process following injury or inflammation within the abdomen. The most common cause is abdominal surgery; nearly all patients undergoing open abdominal surgery develop them. Procedures involving the lower abdomen and pelvis, such as appendectomies, C-sections, hysterectomies, and bowel surgeries, carry a higher risk. Other causes include infections like peritonitis or appendicitis, and inflammatory conditions such as Crohn’s disease or endometriosis.
The formation process begins with inflammation and activation of the coagulation system, leading to fibrin deposits on damaged tissues. This fibrin acts like a temporary glue, sealing the injured area. If not properly broken down, repair cells migrate into the fibrin matrix. These cells then produce collagen, transforming the temporary fibrin into permanent fibrous scar tissue.
Symptoms and Health Impacts
While many intra-abdominal adhesions do not cause symptoms, they can lead to various health problems. The most significant complication is bowel obstruction, where adhesions can kink or twist the intestines. This blocks the passage of food, fluids, and gas through the digestive tract. Symptoms include severe abdominal pain, cramping, bloating, nausea, vomiting, and an inability to pass gas or stool. A complete obstruction is a serious medical emergency requiring immediate treatment.
Adhesions can also cause chronic abdominal pain, persistent or intermittent. This pain often results from adhesions pulling on nerves or organs, or from increased muscle contractions. The discomfort can be vague, crampy, and difficult to pinpoint.
In women, pelvic adhesions can affect reproductive organs, such as fallopian tubes, ovaries, and uterus. This can interfere with egg movement, potentially leading to infertility or increasing the risk of ectopic pregnancy. Adhesions can also cause discomfort during physical activity or exercise.
Diagnosis and Management
Diagnosing intra-abdominal adhesions is challenging due to non-specific symptoms that mimic other conditions. Doctors consider a patient’s medical history, especially previous abdominal surgeries, and perform a physical examination. While routine imaging tests like X-rays or CT scans cannot directly visualize adhesions, they are valuable for detecting complications such as intestinal blockages. A CT scan, for instance, can show an abrupt transition from dilated to collapsed bowel segments, hinting at an obstruction.
Definitive diagnosis often requires a surgical procedure, such as laparoscopy or laparotomy, for direct visualization of the abdominal cavity. During laparoscopy, a small incision allows a camera and instruments to be inserted, enabling the surgeon to identify and cut adhesion bands in a procedure called adhesiolysis.
Mild symptoms or partial obstructions may be managed conservatively through dietary adjustments, pain medication, and close monitoring. Surgical intervention, or adhesiolysis, is necessary for complete bowel obstructions, severe chronic pain, or infertility caused by adhesions.
To prevent adhesion formation during surgery, meticulous surgical techniques are employed, such as gentle tissue handling, optimal hemostasis, and avoiding tissue desiccation. Additionally, barrier agents can be placed between injured surfaces to reduce adhesion formation.