Abdominal Adhesions Symptoms, Diagnosis, and Treatment

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Abdominal adhesions are important because they are a common cause of abdominal symptoms, particularly abdominal pain. The term adhesions refers to the formation of scar tissue between bowel loops (small or large intestine) and the inner lining of the abdominal wall (peritoneal lining) or with other organs within the abdominal cavity (liver, gallbladder, uterus and its attached Fallopian tubes and ovaries, and urinary bladder). Adhesions can also form between loops of the small and large intestine.

Adhesions form when inflammation occurs on the surface of the abdominal organs or the peritoneal lining of the abdominal cavity; the formation of scar tissue is a normal part of healing when there is inflammation. The cause of the inflammation can vary considerably. It may be due to inflammation of an organ (for example, cholecystitis, appendicitis), prior surgery in which organs or the peritoneal lining are cut, inflammation of the peritoneal lining of the abdomen (peritonitis), or abdominal radiation treatment. Other causes of inflammation and scarring include:

  1. handling of abdominal organs at the time of surgery,
  2. foreign objects left inside the abdomen at the time of surgery (for example, a piece of gauze),
  3. bleeding into the peritoneal cavity, and
  4. gynecological conditions (for example, pelvic inflammatory disease).

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.