Abdominal adhesions, often described as internal scars, are bands of tissue that develop inside your abdomen, bridging organs to each other or to the abdominal wall. These adhesions can cause surfaces within the abdomen, which are naturally designed to move freely, to stick together. While many individuals may develop abdominal adhesions, especially after surgery, the critical aspect lies in their diagnosis and management, particularly when they lead to complications.
These internal scar tissues can exert a significant impact, potentially kinking, twisting, pulling, or compressing the intestines and other abdominal organs. This mechanical stress can lead to a range of symptoms and serious complications, such as intestinal obstruction or blockage. Therefore, effective Adhesions Diagnosis is paramount in addressing related health issues.
Abdominal Adhesions: How Common Are They?
Abdominal adhesions are a frequently encountered condition, with abdominal surgery being a primary catalyst for their formation. Surgical procedures, whether laparoscopic or open, involve entering the abdominal cavity through incisions. Laparoscopic surgery, a less invasive approach, utilizes small incisions and specialized tools for viewing and operating on internal organs. Open surgery, conversely, requires a larger incision to provide broader access to the abdomen.
It’s noteworthy that abdominal adhesions are observed in over 90% of patients undergoing open abdominal surgery. However, it’s crucial to understand that the majority of these individuals will not experience symptoms or complications. Laparoscopic surgery is associated with a lower incidence of adhesion development compared to open surgery.
Who is at Higher Risk for Abdominal Adhesions?
Individuals with a history of abdominal surgery are predisposed to developing abdominal adhesions. Within this group, certain factors elevate the risk of adhesions and subsequent complications:
- Emergency Abdominal Surgery: Urgent surgical interventions often carry a higher risk.
- Pelvic or Lower Digestive Tract Surgery: Procedures involving the pelvic region or the lower digestive system, including the colon and rectum, increase the likelihood of adhesion formation.
Complications Arising from Abdominal Adhesions
Abdominal adhesions can lead to significant health complications, primarily intestinal obstruction and female infertility. Timely and accurate adhesions diagnosis is crucial to mitigate these risks.
Intestinal Obstruction
Intestinal obstruction refers to a partial or complete blockage that impedes the normal passage of food, fluids, air, and stool through the intestines. Abdominal adhesions stand out as the most prevalent cause of small intestine obstruction. This blockage can have severe consequences, including:
- Ischemia and Tissue Necrosis: Lack of blood supply to the obstructed intestinal segment can lead to tissue death.
- Peritonitis: Infection of the abdominal cavity lining, a life-threatening condition.
Intestinal obstruction is a serious medical emergency. Individuals experiencing symptoms indicative of a complete blockage, such as severe abdominal pain and the inability to pass fluids, stool, or gas, should seek immediate medical attention. Prompt adhesions diagnosis in such cases is vital for effective intervention.
Female Infertility
In women, abdominal adhesions located in the pelvic region or within the uterus can compress or obstruct reproductive organs, leading to infertility. Diagnosis of adhesions in this context is essential for fertility management and treatment planning.
Recognizing Symptoms of Abdominal Adhesions
In many instances, abdominal adhesions remain asymptomatic, causing no noticeable health issues. However, when symptoms do manifest, chronic abdominal pain is the most frequently reported complaint.
Abdominal adhesions can also trigger intestinal obstruction, a potentially life-threatening condition. Therefore, recognizing the symptoms of intestinal obstruction and seeking timely medical help is critical. Effective adhesions diagnosis is key to addressing these complications.
Symptoms of intestinal obstruction may include:
- Severe abdominal cramps
- Nausea
- Vomiting
- Bloating
- Constipation
- Inability to pass gas
If intestinal obstruction progresses and compromises blood flow to the affected intestinal segment or leads to peritonitis, additional symptoms may develop, such as rapid heart rate and fever. These signs further underscore the urgency of seeking medical attention and obtaining a prompt adhesions diagnosis.
What Triggers Abdominal Adhesion Formation?
Abdominal surgery is the most common culprit behind abdominal adhesions. Adhesions resulting from surgery are more likely to cause symptoms and complications compared to those arising from other causes. It’s important to note that symptoms and complications can emerge at any point after surgery, even years later.
Conditions characterized by inflammation or infection within the abdomen can also contribute to adhesion development. These include:
- Crohn’s disease
- Diverticular disease
- Endometriosis
- Pelvic inflammatory disease
- Peritonitis
Other less common causes of abdominal adhesions include long-term peritoneal dialysis for kidney failure and radiation therapy for cancer treatment. In rare cases, abdominal adhesions may be present at birth.
Abdominal surgery is the leading cause of abdominal adhesions.
Adhesions Diagnosis: Methods Used by Doctors
Doctors employ a combination of medical history review, physical examination, blood tests, imaging studies, and, in some instances, surgical exploration to diagnose abdominal adhesions and related complications. The focus of adhesions diagnosis is often on identifying the consequences of adhesions, such as intestinal obstruction.
Medical History: A Crucial Diagnostic Tool
A doctor will initiate the diagnostic process by gathering a detailed medical history. This includes inquiries about your symptoms, prior abdominal surgeries, and any pre-existing conditions that might predispose you to abdominal adhesions. The medical history also helps rule out other conditions that may mimic the symptoms of adhesions.
Physical Examination: Assessing Abdominal Condition
During a physical exam, the doctor may palpate your abdomen to assess for tenderness or pain. A stethoscope is used to listen to bowel sounds, which can provide clues about intestinal obstruction. However, physical examination alone is often insufficient for a definitive adhesions diagnosis.
Blood Tests: Supporting the Diagnostic Process
While blood tests cannot directly diagnose abdominal adhesions, they play a valuable role in excluding other potential health issues that could be causing your symptoms. In cases of suspected intestinal obstruction, blood tests can help determine the severity of the obstruction and assess the patient’s overall condition.
Imaging Tests: Visualizing Complications
Imaging tests are often instrumental in adhesions diagnosis, particularly in identifying complications like intestinal obstruction. While adhesions themselves may not always be directly visible on standard imaging, these tests can reveal signs of obstruction and help rule out other conditions.
Imaging modalities used may include:
Imaging tests are used to diagnose intestinal obstruction caused by abdominal adhesions and to exclude other potential problems.
Surgical Diagnosis: Direct Visualization
In certain situations, doctors may recommend surgery, either laparoscopic or open, to directly visualize the abdominal cavity and confirm the presence of adhesions or other underlying issues. This surgical exploration can be both diagnostic and therapeutic, as surgeons can often address the problem during the same procedure. This is often considered the most definitive method for adhesions diagnosis.
Treatment Strategies for Abdominal Adhesions
If abdominal adhesions are asymptomatic and not causing any complications, treatment is typically not required. The focus shifts to intervention when adhesions lead to symptoms or complications.
In symptomatic cases, surgical release of adhesions, known as adhesiolysis, can be performed via laparoscopy or open surgery. However, it’s important to acknowledge that surgery to treat adhesions can paradoxically lead to the formation of new adhesions. A thorough discussion with your doctor about the potential benefits and risks of surgery is crucial.
For intestinal obstruction caused by abdominal adhesions, prompt hospital treatment is necessary. Doctors will evaluate the situation to determine if emergency surgery is needed. If surgery is required, surgeons will release the adhesions to relieve the obstruction.
In non-emergency situations, doctors may initially attempt to manage the obstruction without surgery. This may involve intravenous (IV) fluid administration and nasogastric tube insertion to decompress the digestive tract. In some instances, the obstruction may resolve spontaneously. If non-surgical management fails, surgery to release adhesions becomes necessary.
Preventing Abdominal Adhesions During Surgery
Surgeons take proactive measures during abdominal surgery to minimize the risk of postoperative abdominal adhesions and related complications. These preventative strategies include:
- Laparoscopic Approach: When feasible, laparoscopic surgery is preferred over open surgery due to its lower adhesion risk.
- Gentle Tissue Handling: Minimizing tissue trauma during surgery is crucial.
- Foreign Material Control: Steps are taken to prevent foreign materials from entering the abdomen, such as using powder-free gloves and lint-free instruments.
- Adhesion Barriers: In some cases, surgeons may apply special film-like barriers to cover damaged tissues inside the abdomen at the end of surgery. These barriers help separate tissues during healing and are eventually absorbed by the body.
Clinical Trials and Ongoing Research
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) are actively involved in research related to digestive disorders, including abdominal adhesions.
Clinical trials are essential for advancing medical knowledge and improving patient care. By volunteering in clinical studies, individuals contribute to a better understanding of diseases and the development of more effective treatments. Ongoing research in abdominal adhesions focuses on enhancing diagnostic methods, refining treatment approaches, and exploring preventative strategies. Further advancements in adhesions diagnosis and management are continually being sought through these research efforts.
To explore clinical studies on abdominal adhesions, visit ClinicalTrials.gov. Always consult with your healthcare provider before participating in any clinical study.
References
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Last Reviewed June 2019
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.
The NIDDK would like to thank: Patricia L. Roberts, M.D., Lahey Hospital and Medical Center, Burlington, Massachusetts
