Abdominal Adhesions

Abdominal adhesions are pathological bands of scar tissue that forms between two previously separated structures within an abdomen. They may be between omentum, abdominal wall or intestinal loops.

ETIOLOGY
– Congenital or Acquired
– Iotragenic; trauma, surgery or postinflammatory

RISK FACTORS
– Emergent surgeries
– Lower GI procedures
– H/o abdominal abscess, surgery or trauma

CLINICAL FINDINGS
– Crampy abdominal pain
– Nausea and/or vomiting
– Minimal to no flatus
– Borborygmi (loud bowel sounds)
– Abdominal distention and tenderness
– Vitals: fever, tachycardia
– Peritoneal signs; guarding, rebound and rigidity

INVESTIGATIONS
– WBC, Lactate, Electrolytes, BUN/Cr
– Abdominal xray
– Water soluble oral contrast

MANAGEMENT
– NG tube decompression
– Adhesiolysis; note that there is always risk for new adhesions with this
– Laparoscopic removal of adhesions
– Laparatomy for small bowel obstruction

REFERENCES:
1. Moris D, Chakedis J, Rahnemai-Azar AA, et al. Postoperative abdominal adhesion: clinical significance and advances in prevention and management. J Gastrointest Surg. 2017;21(10):1713–1722.
2. Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. J Surg Res. 2011;165(1):91–111.