Why do adhesions form?
The peritoneum is covered with a slippery layer of cells, thanks to which the intestinal loops move freely relative to each other. If this layer is damaged - during surgery, due to inflammation, hemorrhage or foreign contents - fibrin falls on the surface, gluing adjacent areas. Normally, fibrin is absorbed within a few days, but if this process is disrupted, vessels and connective tissue grow into the glue, and a strong cord is formed. The more extensive the operation and the longer the inflammation lasted, the higher the likelihood of adhesions.
- Surgeries on the abdominal cavity and pelvis
- Peritonitis and appendicitis
- Inflammation of the uterine appendages
- Endometriosis
- Abdominal injuries
- Radiation therapy to the abdomen
How does adhesive disease manifest?
Most adhesions are asymptomatic and discovered incidentally during another operation. With adhesive disease, nagging or aching pain in the abdomen appears, often associated with physical activity, straining and a certain body position. Characterized by bloating, rumbling, a tendency to constipation, and discomfort after eating. In women, adhesions in the pelvis can cause pain in the lower abdomen, pain during sexual intercourse, and cause difficulties in getting pregnant due to obstruction of the fallopian tubes.
- Nagging pain that gets worse with exercise
- Bloating and rumbling in the stomach
- Tendency to constipation
- Discomfort after eating
- Pain in the lower abdomen in women
- Difficulty getting pregnant
Adhesive intestinal obstruction
The most dangerous complication occurs when the adhesion pulls on a loop of intestine or it twists around a cord. A cramping pain appears, which comes in waves, the passage of gas and stool stops, the stomach swells, vomiting begins - first with the food eaten, then with stagnant contents. If the vessels of the mesentery are compressed, a section of the intestine may become dead, and then the pain becomes constant, the temperature rises, and the condition worsens sharply. Adhesive obstruction is one of the most common causes of emergency abdominal surgery.
- Cramping wave-like pain
- Stopping the passage of gas and stool
- Bloating
- Vomiting with stagnant contents
- Deterioration of general condition and temperature
- Urgent hospitalization required
Diagnostics
It is most often impossible to see the adhesions themselves on an ultrasound or x-ray, so the diagnosis is based on the history of previous operations, the nature of the complaints and signs of disruption of the passage of contents. If an obstruction is suspected, a plain radiography of the abdominal cavity is taken, where characteristic levels of fluid in the intestinal loops are visible, and a CT scan, which helps to find the location of the obstruction. For chronic complaints, contrast passage examination and irrigoscopy are used. The most reliable, but also the most invasive method is diagnostic laparoscopy.
- Detailed history of previous operations
- Plain radiography of the abdominal cavity
- Abdominal CT
- Study of contrast passage and irrigoscopy
- Ultrasound to rule out other causes of pain
- Diagnostic laparoscopy in difficult cases
Treatment and prevention
For chronic complaints without obstruction, treatment is conservative: small meals with limited gas-causing foods, regular bowel movements, moderate physical activity, physiotherapy as prescribed by a doctor. In case of adhesive obstruction, they begin with observation, placement of a probe and infusion therapy; if patency is not restored or there are signs of intestinal necrosis, an operation is performed with dissection of adhesions. It is important to understand that the operation itself contributes to the formation of new adhesions, so it is carried out according to strict indications, and not for prevention.
- Small meals, fewer gas-producing foods
- Regular bowel movements and sufficient fluids
- Moderate physical activity
- Physiotherapy as prescribed by a doctor
- Surgery for adhesive obstruction
- Laparoscopic approach reduces the risk of new adhesions
