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Abdominal Adhesion
A Common cause of Chronic Abdominal Pain

Abdominal adhesions are fibrous bands or thread-like scar materials formed in the abdomen following surgery, trauma, bleeding, infection or endometriosis.

They notoriously make tissues and internal organs to stick to one another or to the surface of the abdominal wall or pelvis, often leading to abdominal pain of varying degree or other complications like chronic (long lasting) abdominal or pelvic pain, infertility, problems with voiding of urine, and intestinal obstruction.

Adhesions may be congenital or even follow non-invasive procedures like radiotherapy.

These bands are formed as part of normal healing process, but their production and clearance could become defective due to operating condition, or one’s innate predispositions.

They are like scars following a healing wound on the skin, but become drawn out like cords. They are sometimes called internal scars. Some have well described these bands like strong spider webs formed in the abdomen or pelvis.

Like spider webs, they are very sticky, and may cause tissues or organs to stick to one another in the space in which there are formed.

Abdominal adhesions are usually not formed until about 4 to 6 weeks after surgery or an overwhelming infection or trauma, and may take even years before symptoms are noticed.

Over 90 percent of patients who undergo abdominal surgery and up to 100 percent of those undergoing major pelvic or gynaecological operations develop adhesions. It is not every one with adhesions that become symptomatic. Only about a third of people with adhesions do eventually develop symptoms.

Symptoms of abdominal or pelvic adhesions include crampy or sharp abdominal pain, bloating, vomiting, or even full blown distended abdomen with vomiting and inability to open ones bowel (when there is intestinal obstruction).

Abdominal adhesions are more common following operation for appendicitis (worse still if it ruptured) and any operation on the large bowel (colon adhesion).

Common surgical and medical conditions that could predispose to formation of pelvic or abdominal adhesion include cholecystectomy (removal of the gall bladder), ruptured appendicitis and subsequent appendicectomy, any bowel surgery, pus in the abdominal cavity, peritonitis, endometriosis, caesarean section (c-section adhesion), ectopic pregnancy repair, and indeed any major pelvic or abdominal surgery.

Techniques like mopping the internal organs dry during surgery, use of starch or talc containing gloves, use of meshes intra-abdominally all contribute to abdominal adhesion formation. Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) or steroids and antihistamines intra-abdominally, carboxymethylcellulose (CMC) and hyaluronic acid has been used in reducing abdominal adhesions formation.

Reference:

Liakakos Tet alPeritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management.Dig Surg. 2001; 18(4):260-73.

Monk BJet alAdhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention.Am J Obstet Gynecol. 1994 May; 170(5 Pt 1):1396-403.

Holmdahl L, et al. Adhesions: pathogenesis and prevention-panel discussion and summary.Eur J Surg Suppl. 1997 ;(577):56-62.

Risberg B. Adhesions: preventive strategies.Eur J Surg Suppl. 1997 ;(577):32-9.

Matter I, et al. (1997) Does the index operation influence the course and outcome of adhesive intestinal obstruction?Eur J Surg 163(10): 767–72

Abdominal Adhesion A Common cause of Chronic Abdominal Pain

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Abdominal Adhesion
A Common cause of Chronic Abdominal Pain