Abdominal adhesions

What is abdominal adhesions?

Abdominal adhesions are bands of scar-like tissue that join abdominal organs to each other or to the abdominal wall. They can kink, twist, pull or compress the bowel. Adhesions are very common after abdominal surgery, but most people who have them never develop symptoms or complications from them.

Normally the surfaces of the bowel and other abdominal organs are smooth and slippery, so they slide past each other as you move. After surgery, infection or inflammation, scar-like bands can form between these surfaces and hold them together. They often cannot be seen on scans, and symptoms may start at any time after surgery, even many years later.

What causes abdominal adhesions?

Abdominal surgery is the most common cause of adhesions, and they develop in more than 9 out of 10 people after open abdominal surgery. Risk is higher after emergency surgery and operations on the colon, rectum or pelvis. Infection, inflammation such as Crohn's disease or endometriosis, and radiotherapy can also cause them.

• Previous abdominal or pelvic surgery, the most common cause
• Emergency operations and surgery on the colon, rectum or pelvic organs, which carry a higher risk
• Infection or inflammation inside the abdomen, such as a burst appendix or peritonitis
• Crohn's disease, diverticular disease, endometriosis or pelvic inflammatory disease
• Radiotherapy to the abdomen, or long-term peritoneal dialysis
• Rarely, adhesions present from birth

What are the symptoms?

Most abdominal adhesions cause no symptoms. When they do, long-term abdominal pain is the most common complaint. If adhesions block the bowel, they cause crampy pain, bloating, a swollen abdomen, nausea, vomiting and being unable to pass wind or stool, which needs urgent care.

• No symptoms at all in most people
• Long-term or recurring abdominal pain
• Crampy pain, bloating and a swollen abdomen if the bowel becomes blocked
• Nausea and vomiting with an obstruction
• Being unable to pass wind or stool with an obstruction

When should I worry about abdominal adhesions?

Seek emergency care for abdominal pain with vomiting and no wind or stool passing, a swollen tender abdomen, or pain with fever or a fast heart rate, especially after previous surgery. These suggest a bowel obstruction. Ongoing abdominal pain without these signs should be assessed at a clinic appointment.

The warning signs below need prompt attention.

• Abdominal pain with vomiting and no wind or stool passing
• A swollen, tender abdomen that is getting worse
• Fever or a fast heart rate with abdominal pain
• Severe, constant pain after previous abdominal surgery

How is it diagnosed?

Adhesions are hard to diagnose because scans usually cannot show them. Doctors use your surgical history, examination, blood tests and imaging such as CT to find a blockage or rule out other causes. A contrast X-ray helps guide treatment of an obstruction, and keyhole surgery is sometimes used to look directly.

• Questions about your symptoms and all previous abdominal operations or infections
• Examination of the abdomen
• Blood tests to rule out other causes and judge how unwell you are
• CT scan or X-rays, which usually cannot show adhesions themselves but can show a blockage they cause
• An X-ray with a water-soluble contrast drink in adhesive obstruction, which helps decide whether surgery is needed
• Laparoscopy (keyhole look inside the abdomen) in selected cases, sometimes treating the problem at the same time

How are abdominal adhesions treated?

Adhesions without symptoms need no treatment. A bowel obstruction from adhesions is treated in hospital with a drip and a stomach tube, and many settle this way. Surgery to divide adhesions, by keyhole or open methods, is used when a blockage does not settle or the bowel is at risk.

• No treatment for adhesions that cause no symptoms
• For a blockage: hospital care with a drip and a tube through the nose to empty the stomach
• Close monitoring, as many adhesive blockages settle without surgery
• Surgery to divide the adhesions if the blockage does not settle or the bowel is at risk
• Keyhole release in selected cases, or open surgery when needed
• Careful discussion of benefits and risks before any planned operation for adhesions

What are the risks and complications?

The main risk of adhesions is small bowel obstruction, which can cut off the bowel's blood supply. Pelvic adhesions can affect fertility in women. Surgery to release adhesions carries its own risks, including injury to the bowel, and can cause new adhesions, so it is used carefully.

• Small bowel obstruction, which can cut off blood supply to the bowel
• Peritonitis if the blocked bowel is damaged
• Fertility problems in women when adhesions involve the pelvic organs
• New adhesions forming after any operation, including surgery to release them
• General risks of surgery, including injury to the bowel