About Abdominal Adhesions

Introduction

Definition of abdominal adhesions

Abdominal adhesions are bands of scar-like tissues found in the abdominal region. They occur between two or more organs or between the organs and the abdominal wall, causing the surface of the organs and abdominal walls to stick together.¹

Abdominal adhesion develops in 9/10 people who’ve had open abdomen surgery. Most people with symptoms of abdominal adhesions don’t show complications, and it is less common for those who have had less invasive surgeries.¹

Importance of understanding abdominal adhesions

“Scar tissue development needs to be supported”. The complications that can arise with scar tissue formation are much more complex than with normal cellular growth.² This is especially important in the abdomen as it’s an area with a high degree of movement. The simple act of breathing alone, whether sitting down or running, puts a high degree of strain on the abdomen in addition to the constructive healing process. 

Causes

Surgery and trauma

The first phase of scar tissue formation is the inflammatory phase.² This is our immune systems’ response to damage to the body. Despite common conception, inflammation doesn’t always lead to bruising and is in fact, a good thing. It is our body mobilizing repair cells (macrophages and histiocytes) to heal the damaged site by removing damaged tissue.³ This phase lasts 24-48 hours, so it is vital to remain immobile to avoid further damage during the healing process.² 

Inflammation and infection

Abdominal adhesion is already a severe problem, especially for those who undergo open surgeries in the abdominal region due to the healing process. It can lead to more complications like the malformation of internal organs in the abdominal area.³

Radiation therapy

“Cancer is a disease caused when cells divide uncontrollably and spread into surrounding tissues. Radiation therapy is a common treatment given to cancer patients. Radiation therapy to the abdominal area can result in tissue scarring. Fortunately, there are many different forms of cancer treatments, as well as imaging technologies, to thoroughly assess it and treat it correctly without damaging healthy cells. 

Genetics

There is a genetic predisposition to post-operative adhesion development. It can often lead to malformation in most cellular repair mechanisms. This can range from the digits in our hands, leading to webbed hands, to the healing and proper formation of scar tissue in the abdomen and organs in the abdominal region.⁴ 

Symptoms

Symptoms vary from person to person. Some do not experience any symptoms, some experience mild symptoms and some experience symptoms that interfere with their day-to-day activity. 

Abdominal pain and discomfort

When cellular structures are malformed, sticking occurs leading to pain and discomfort. Since the abdominal region is highly prone to movement stress, it is vital to remain immobile to avoid residual complications.³ These complications include abdominal pain, bloating, constipation, bowel obstruction, nausea, and vomiting.¹

Bowel obstruction

Abdominal adhesions are serious. Post-operative malformation of scar tissue can lead to numerous residual complications, including bowel obstructions. After open abdominal surgery, it is vital to remain immobile within reason. Human bodily functions are natural and proper bowel movement is important. If you have any complications, consult your doctor or nutritionist to find better solutions for the obstruction. Other compilations to be wary of with bowel obstructions include:  

• Loss of appetite
• Fever
• Blood in stool
• Green or yellow-green vomit
• Lethargy
• Swollen or firm belly

Infertility

The cellular malformation can mobilize and migrate to other body regions, causing several residual effects. Adhesion can lead to normal pelvic anatomy distortion, which can decrease mobility and function, particularly fertility. More commonly, adhesions in the fallopian tubes or ovaries may prevent the embryo from travelling to the uterus and cause ectopic pregnancy. This refers to the misplacement of a fertilized egg, typically in 1 of the fallopian tubes. It happens in approximately 1 in 100 pregnancies.

Several residual symptoms can arise, although by being proactive in developing proper post-operation healing plans, these effects can be mitigated. This is especially pertinent in 24-48 hours following your surgery. It’s normal to worry post-operation. Typically this process is managed by a team of clinical specialists, including surgeons, gastroenterologists, pain management specialists, nurses, dietitians, and social workers.

Diagnosis

Medical history and physical examination

With abdominal adhesions, doctors use medical history, physical exams, blood tests, imaging tests, and, in some cases, surgery for diagnosis.¹

Imaging tests

Imaging tests are useful in the field of adhesion testing and diagnosis. Even though they do not definitively show an abdominal adhesion, they can rule out other problems. The imaging tests available include:¹

• CT scan, utilizing X-rays and computer technology, aids in diagnosing intestinal obstruction by identifying its location, cause, and severity 
• X-rays, involving minimal radiation exposure, generate internal body images 
• X-rays with a water-soluble contrast medium can detect adhesions causing an obstruction and indicate the need for surgery while also potentially relieving the obstruction. Lower GI series utilizes X-rays to examine the large intestine

Laparoscopy

Abdominal adhesion more commonly occurs as a result of open abdomen surgery. Laparoscopy is a less invasive surgery in the abdomen and pelvis through which an individual can refrain from making larger incisions and incur the risk of residual effects.¹

Treatment

Treatment is not required in cases where abdominal adhesions cause no symptoms or complications.¹ 

Non-surgical treatments

There are some suitable alternatives to surgery; these tools can act as remedies to treat acute or chronic pain. They can also act as a means to facilitate improved healing of scar tissue. These include:

• Medication: Often used for acute pain and can be an accompanying treatment for chronic pain
• Physical therapy
• Lifestyle Changes
• Soft tissue mobilization

Surgical treatments

There are two suitable forms of surgery: open or closed surgery. Patients who undergo open surgery can be more prone to the development of infections at a later date. Laparoscopic or closed surgery is a safer alternative between the two as it is less invasive and allows the patient to have fewer residual incisions.³

Complication

Bowel obstruction

Complete bowel obstruction 

This occurs when the bowel is completely blocked and stops working. This is a medical emergency as it can become life-threatening if left untreated. If you are unable to pass gas or stools and are in a lot of pain, please seek medical help immediately. 

Strangulated bowel obstruction

This occurs when the bowel gets twisted around the band of adhesion tightly, thereby cutting off the blood supplyInfertility.This is a medical emergency as it can become life-threatening if left untreated. You might experience severe abdominal pain, fever, bleeding from the anus etc. Please visit an ER if you experience any or all of these symptoms.

Infertility

Infertility is the result of abnormal pelvic formation. This is the result of metastasized scar tissue formation. This decreases mobility and function in the pelvis, which is a particular function of fertility. More commonly, adhesions in the fallopian tubes or ovaries may prevent the embryo from travelling to the uterus and cause ectopic pregnancy. This refers to the misplacement of a fertilized egg, typically in 1 of the fallopian tubes. It happens in approximately 1 in 100 pregnancies.

Prevention

Proper wound care

Proper wound care is vital to prevent infection post-operation as it contributes to healthy scar tissue formation. The key tools include:⁴ 

• Keeping the wound clean and dry: Cleaning the wound with unscented mild soaps. Ensuring the wound isn’t aggravated while scrubbing or drying
• Dressing the wound properly: Dressing the incision with a sterile covering such as gauze or a bandage
• Activity Restrictions: The abdomen is a region prone to a high degree of stretching, so remaining immobile and avoiding strenuous activity following your operation is crucial
• Medication: Medication can be prescribed as a remedy for acute or chronic pain
• Watch for signs of infection: Signs of infection include residual symptoms as well as visible symptoms such as metastasized scar tissue, fever, and redness or discharge at the incision site. Contact your doctor immediately if these symptoms arise

Use of barrier products

These allow improved formation of scar tissue post-operation, reducing the risk of any adhesion formations. Common barrier products include:⁴

• Intercede: An absorbable adhesion barrier composed of oxidized regenerated cellulose. It is placed between the organs during surgery
• Seprafilm: A bioresorbable adhesion barrier composed of hyaluronate and carboxymethylcellulose. It is placed between the organs during surgery.
• SurgiWrap: An absorbable adhesion barrier composed of polyethene glycol. It is placed between the organs during surgery

Early ambulation

It is encouraged to undergo light activity post-operation to promote proper healing. Staying in bed for too long can lead to resulting symptoms such as blood clots, pneumonia, and muscle weakness. The timing of this depends on the instructions from your surgeons and medical team.⁵

Summary

Abdominal adhesions are a serious condition more common among patients who undergo open surgery. Without the proper treatment, there can be residual effects. It is important to follow the instructions of your surgeon and medical team to ensure proper healing post-operation.