Diseases

Abdominal adhesions are difficult to prevent. However, careful, gentle, surgical techniques can minimize the formation of adhesions. Laparoscopic surgery avoids opening up the abdomen with a large incision. Instead, the abdomen is inflated with gas (carbon dioxide) while special surgical tools and a video camera are threaded through a few, small abdominal incisions. Inflating the abdomen gives the surgeon room to operate. If a large abdominal incision is required, a special filmlike material (Seprafilm) can be inserted between organs or between the organs and the abdominal incision at the end of surgery. The filmlike material, which looks similar to wax paper, is absorbed by the body in about a week and tends to minimize adhesion formation. Other steps during surgery to reduce adhesion formation include using starch- and latex-free gloves, handling tissues and organs gently, shortening surgery time, and not allowing tissues to dry out.

No tests are available to diagnose adhesions, and adhesions cannot be seen through imaging techniques such as X-rays or ultrasound. Most adhesions are found during exploratory surgery. An intestinal obstruction, however, can be seen through abdominal X-rays, barium contrast studies - also called a lower GI series - and computerized tomography.

Treatment for abdominal adhesions is usually not necessary, as most do not cause problems. Surgery is currently the only way to break adhesions that cause pain, intestinal obstruction, or fertility problems. More surgery, however, carries the risk of additional adhesions and is avoided when possible. A complete intestinal obstruction usually requires immediate surgery. A partial obstruction can sometimes be relieved with a liquid or low-residue diet. A low-residue diet is high in dairy products, low in fiber, and more easily broken down into smaller particles by the digestive system.

Abdominal adhesions cause female infertility by preventing fertilized eggs from reaching the uterus, where fetal development takes place. Adhesions can kink, twist, or pull out of place the fallopian tubes, which carry eggs from the ovaries - where eggs are stored and released - to the uterus.

Abdominal adhesions can kink, twist, or pull the intestines out of place, causing an intestinal obstruction. An intestinal obstruction partially or completely restricts the movement of food or stool through the intestines. A complete intestinal obstruction is life-threatening and requires immediate medical attention and often surgery.

Abdominal adhesions are bands of tissue that form between abdominal tissues and organs. these vary from a consistency of wet tissue paper, which are of little significance, to a strong, fibrous band that can readily cause obstruction. Normally, internal tissues and organs have slippery surfaces, which allow them to shift easily as the body moves. Adhesions cause tissues and organs to stick together. Picture of the organs and glands in the abodmen The intestines are part of the digestive system. Abdominal adhesions can cause an intestinal obstruction. Although most adhesions cause no symptoms or problems, others cause chronic abdominal or pelvic pain. Adhesions are also a major cause of intestinal obstruction and female infertility.

Although most abdominal adhesions go unnoticed, the most common symptom is chronic abdominal or pelvic pain. The pain often mimics that of other conditions, including appendicitis, endometriosis, and diverticulitis.

Symptoms of an intestinal obstruction include

• severe abdominal pain, nausea, or cramping
• vomiting
• bloating
• loud bowel sounds
• swelling of the abdomen
• inability to pass gas
• constipation

A person with these symptoms should seek medical attention immediately.

Abdominal surgery is the most frequent cause of abdominal adhesions. Almost everyone who undergoes abdominal surgery develops adhesions; however, the risk is greater after operations on the lower abdomen and pelvis, including bowel and gynecological surgeries. Adhesions can become larger and tighter as time passes, causing problems years after surgery. Surgery-induced causes of abdominal adhesions include

• tissue incisions, especially those involving internal organs
• the handling of internal organs
• the drying out of internal organs and tissues
• contact of internal tissues with foreign materials, such as gauze, surgical gloves, and stitches
• blood or blood clots that were not rinsed out during surgery

A less common cause of abdominal adhesions is inflammation from sources not related to surgery, including

• appendicitis - in particular, appendix rupture
• radiation treatment for cancer
• gynecological infections
• abdominal infections

Rarely, abdominal adhesions form without apparent cause.