Abdominal Adhesions Symptoms and Treatment (cont.)
Bhupinder Anand, MD
Under normal conditions, the loops of the small and large intestines are free to move around within the abdominal cavity, sliding over each other and the surrounding organs over a thin film of lubricating fluid. When adhesions form, the intestines are no longer able to move around freely because they become tethered to each other, the abdominal wall or to other abdominal organs. At the sites where adhesions occur, the intestine can twist on itself, and the twisting may obstruct the normal movement of its contents, particularly in the small intestine. Most of the time the twisting is intermittent, but occasionally the twisting does not reverse spontaneously. The symptoms from adhesions may occur soon after the inflammatory process sets in; however, more typically they occur several months or even many years later.
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).