Abdominal Adhesions Symptoms and Treatment (cont.)
Bhupinder Anand, MD
Although abdominal pain and other symptoms of intestinal obstruction are by far the most common effect of adhesions, another important consequence is infertility in women. The infertility is believed to be caused by adhesions involving the Fallopian tubes that results in kinking and obstruction, thereby preventing the eggs that are released from the ovary from reaching the uterus.
Symptoms caused by adhesions may vary from specific (typical) to non-specific. When the symptoms are typical, the diagnosis is easy since adhesions are the most common cause of intestinal obstruction.
The typical symptoms of obstruction are abdominal discomfort located around the belly button (umbilicus) that is cramp-like, followed by distention of the abdomen. Symptoms often are worsened by eating. There may be reduction in the amount of flatus or stool that is passed and, with prolonged obstruction, nausea and vomiting may occur. When the obstruction is incomplete or intermittent, symptoms may be less severe with abdominal pain or cramping occurring only after meals. Although uncommon, obstruction also may manifest primarily as nausea with or without vomiting, especially when the obstruction occurs in the proximal small intestine near the stomach. It is important to remember, however, that most adhesions do not cause symptoms.
There are no tests that can clearly identify adhesions, but the pattern of obstruction often can be recognized on plain X-ray films of the abdomen by the presence of dilated loops of small intestine. Barium X-rays of the small intestine, specifically the use of small bowel follow through examination, may show abnormal angulation of the intestinal loops that suggest the presence of adhesions. Such a finding, however, does not mean that the adhesions necessarily are responsible for the symptoms. Other tests such as ultrasonography and computerized tomography (CT) are often necessary, primarily to exclude other causes of obstruction, for example, tumors and strictures (bowel narrowing).
The treatment of adhesions is straight-forward. Patients undergo either laparoscopic or open surgery and the adhesions are cut by scalpel or electrical current (lyses). The problem is that adhesions have a tendency to reform, and some individuals have a propensity to form adhesions. Laparoscopic surgery results in fewer adhesions and, theoretically, is a better option; however, whether the adhesions are lysed at laparoscopic or open surgery, the inflammation caused by the process of cutting can result in recurrent adhesions.
Adhesions due to open surgery can be prevented by the use of a product called Seprafilm. Seprafilm is a waxed paper-like film that is placed inside of the abdomen over the incision site. The film covers the incision and keeps tissues adjacent to the incision from sticking to the incision. The incision heals normally with scarring, but the film prevents the scar tissue from spreading to the adjacent tissues to form adhesions. After several days, the film dissolves spontaneously. Seprafilm should be carefully placed because it can slow down the healing (scarring) process. For example, if the film is wrapped around an incision in a hollow organ such as the intestine, the incision may not heal, and a leak from the organ may occur.
REFERENCE: Medscape.com. Postoperative Adhesions: From Formation to Prevention: Pathophysiology.
Last Editorial Review: 6/24/2011 12:48:48 PM