Re: Abdominal Adhesions

From: floyd and alice long (
Wed Jun 14 23:09:11 2000

Helen Dynda wrote: >
> Abdominal Adhesions
> * What is it? * Prevention
> * Symptoms * Treatment
> * What your doctor looks for * When to call your doctor
> * Diagnosis * Prognosis
> * Expected duration * Additional info
> What is it?
> Abdominal adhesions are bands of fibrous scar tissue that form on the
> abdominal organs, causing the organs to stick to one another or to the
> abdominal wall. The fibrous scarring of adhesions may be due to the
> after-effects of peritonitis (an infection of the membrane covering
> the abdominal organs), or it may follow the mechanical injury of
> serious abdominal trauma. However, in patients living in developed
> countries, adhesions most commonly develop after abdominal surgical
> procedures, where organs are handled by the surgical team and
> temporarily shifted from their normal positions.
> In most patients, post-surgical adhesions are inconsequential and
> produce no health problems. Their existence is merely an incidental
> finding on autopsy after a patient's death. In about 3% of
> post-surgical patients, however, fibrous bands of adhesions interfere
> with the normal passage of intestinal contents, causing either a full
> or partial intestinal obstruction. In even fewer cases, a portion of
> the bowel strangulates -twists around a band of adhesions. This
> strangulation cuts off the normal blood supply to the twisted bowel,
> and the affected portion of bowel begins to die. When this happens,
> the patient must be taken to surgery immediately.
> Adhesions are fairly rare in patients who have never had abdominal
> surgery. Among those who have had only one abdominal surgical
> procedure, adhesions occur postoperatively in 67%-81% of cases. Among
> those who have had multiple abdominal surgeries, at least 93% develop
> adhesions.
> Symptoms
> In most patients, abdominal adhesions produce no symptoms. However, if
> adhesions cause partial, transient intestinal obstruction, the patient
> may have intermittent bouts of crampy abdominal pain.
> When more significant intestinal obstruction develops, the patient may
> have the following symptoms:
> ** Severe, crampy abdominal pain - If the obstruction is in the small
> intestine, pain may localize around or above the navel. If the
> obstruction involves the large intestine, abdominal pain may
> concentrate below the navel.
> ** Vomiting - This may produce either clear stomach juices, or
> foul-smelling intestinal juices.
> ** Diarrhea - This is most likely to occur early in the obstruction
> process.
> ** Absent or infrequent bowel movements
> ** Signs of dehydration - These include dry skin, dry mouth and
> tongue, severe thirst, and infrequent urination.
> When strangulation occurs, the patient looks very ill. They have
> severe, constant abdominal pain, together with other symptoms of
> obstruction, plus a fever and a rapid heartbeat.
> What your doctor looks for
> Your doctor will look for symptoms of obstruction or strangulation. He
> or she will also ask you about any surgical procedures you've had, or
> any episodes of peritonitis or severe abdominal trauma.
> Diagnosis
> Your doctor will suspect the diagnosis of intestinal obstruction or
> strangulation based on your symptoms and your surgical history,
> together with the results of your physical examination. In addition to
> the standard physical exam, with special attention to your abdomen,
> your doctor will also perform a rectal examination and (in women) a
> pelvic exam. To find further evidence for the diagnosis, your doctor
> will order blood tests and x-rays of your chest and abdomen. In some
> patients with suspected intestinal obstruction or strangulation, the
> diagnosis is only confirmed at the time of abdominal surgery.
> Expected duration
> Abdominal adhesions are permanent, unless the patient undergoes
> adhesiolysis (a surgical procedure to break up adhesions).
> Prevention
> Patients cannot prevent adhesions. If you are undergoing abdominal
> surgery, your surgeon can minimize the risk for adhesions by using a
> gentle surgical technique, powder-free gloves, and (in some cases)
> FDA-approved absorbable "adhesion barriers" to protect tissue.
> Treatment
> When adhesions produce intestinal strangulation or significant
> intestinal obstruction, abdominal surgery is required.
> When to call your doctor
> Call your doctor whenever you have severe abdominal pain, especially
> if you also have a fever, nausea and vomiting, or infrequent bowel
> movements.
> Prognosis
> Once abdominal adhesions have formed, even adhesiolysis surgery may
> not cure the problem. For example, when surgery is performed to remove
> an intestinal obstruction caused by adhesions, adhesions re-form and
> create a new obstruction in 11%-21% of cases.
> - - - - - - - -
> NOTE: If for some reason this article is difficult to read, please go
> to the following Url.....Enter: "Adhesions" in the upper left-hand
> corner and click: "Go".....Then click: "Abdominal Adhesions."

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