Abdominal Adhesion



Abdominal Adhesion

What is an Abdominal Adhesion, and Who Gets It?

An abdominal adhesion is thread-like scar material, or fibrous bands, that form in the abdomen as part of the healing process after abdominal trauma, abdominal bleeding, infection, endometriosis, or after a surgical procedure in the abdomen.

You can think of an abdominal adhesion as you would scar tissue that remains on the skin after a wound heals. The difference is an abdominal adhesion tends to form into cord-like structures that can wrap around abdominal muscles and tissues, causing them to stick together, or stick to the abdominal wall itself.

When this happens, an abdominal adhesion can cause chronic, long-lasting pain and other complications such as infertility, difficulties voiding urine, and intestinal obstruction. These problems can be costly to treat, and can easily leave long-time sufferers under financial stress (Obstetrics and Gynecology International).

How Common is Abdominal Adhesion?

The occurrence of an abdominal adhesion is relatively common, showing up in about 93% of patients who undergo some form of abdominal surgery, and affecting 1 in 10 patients who have never undergone an abdominal procedure. Abdominal adhesion is most common in patients who have undergone a procedure in the lower pelvis such as an appendectomy, or gynecological operations such as hysterectomy or cesarean section). Adhesion following surgery are referred to as postoperative peritoneal adhesions (PPAs).

Conditions and Procedures that Increase Your Chances of Developing Abdominal Adhesions

An abdominal adhesion is usually the result of some form of trauma to the abdomen. In rare cases, abdominal adhesions can be congenital (present at birth) or occur as the result of a non-invasive procedure like radiotherapy.

As well, traits such as a patient’s genetic predisposition to adhesion formation, age, the presence of infection of an operated site, and other factors can also contribute to a patient’s likelihood of developing abdominal adhesions.

In most people, an abdominal adhesion will be caused by one or more of the following: 

  • Appendicitis, especially if there was pus in the abdominal cavity during the operation or if the appendix ruptured  
  • Hysterectomy
  • Cesarean Section
  • Cholecystectomy (removal of the gall bladder)

Symptoms of Abdominal Adhesion

It is possible to have abdominal adhesions and demonstrate no symptoms at all, In fact, only about one-third of people with adhesions eventually develop symptoms. While pelvic adhesions form 4 to 6 weeks after abdominal trauma, it can take years before symptoms manifest.

Symptoms of pelvic adhesions can include:

Abdominal Pain

Abdominal pain is the most common symptom of pelvic adhesion. In a recent study, abdominal or pelvic adhesion were found at laparoscopy in more than 25% of women suffering from chronic pelvic pain. Only 10% of women without chronic abdominal or pelvic pain were found to have abdominal adhesion.

The pain in the abdomen occurs because over time, adhesion tissues can develop their own nerve fibres and blood vessels, which cause pain when these nerves are stretched by bowel movements or other factors inside the abdominal cavity. This pain can be sharp and intermittent or dull and more persistent.

Bowel or Intestinal Obstruction

The 2 October 2012 issue of Frontiers in Medicine, report adhesive small bowel obstruction is a frequent cause of hospital admission. Adhesions can spread in a web-like formation inside the abdominal cavity and restrict the normal flow of bowel through the intestines.  Symptoms of bowel obstruction include colicky abdominal pain, nausea, a feeling of been bloated, vomiting and inability to go to the loo (open one's bowel). Occasionally, the bowel is able to "free" itself from the grip of adhesions and symptoms may resolve on their own.

Infertility

Infertility can be the result of abdominal adhesion in those who have had a major abdominal operation, who suffer with endometriosis, or who are known to have had an abdominal or pelvic infection like PID, salpingitis, or peritonitis. The bands form by abdominal adhesions an affect the architecture of the abdomen, interfering with the release of eggs from the ovary, or the migration of a fertilized ovum into the fallopian tubes and womb (uterine adhesions).

Treatment for Abdominal Adhesion

The best available treatment for repair abdominal adhesion is by keyhole surgery or laparoscopy to break and remove pelvic adhesions in a procedure called adhesion lysis. Many patients report significant improvement in their overall health, as well as a very low incidence of recurrence.

There are risks, however. Since abdominal surgery is one of the primary causes of pelvic adhesions, it is possible for patients who have adhesion lysis to need more procedures in the future, sometimes as often as every two years. This occurs in few than 2 in 10 cases.

Some adhesion lysis surgeons will opt to delay the surgery 12 to 24 hours to inject the abdominal cavity with liquids containing carboxymethylcellulose (CMC), hyaluronic acid, or icodextrin ahead of surgery in hopes of reducing the chances of the abdominal adhesions forming after the corrective surgeries.

Alternative, NonSurgical Treatments and Prevention Of Abdominal Adhesion

A recent study finds that taking a fish oil supplement may be an effective adjuvant therapy to reduce the development of postsurgical adhesions related to endometriosis. This is according to Fertility and sterility, (25 October 2012, 1556-5653).

Unless patients have congenital adhesions, the formation of adhesions can be controlled, or minimized to some extent, if patients are willing to take certain measures before, during, and after a surgical procedure.

Preventative measures include:

  •  Pre-emptively assess the likelihood of adhesion in a procedure and take steps to reduce its occurrence
  • Opting for laparoscopic surgery when possible rather than open abdominal or pelvic surgery
  • Avoiding the use of starch- or talc-containing surgical operating gloves
  • Avoiding the use of mesh intra-abdominally, if possible
  • Careful surgery with reduced bowel handling
  • Using carboxymethylcellulose (CMC) and hyaluronic acid intra-operatively inside the abdominal cavity to create viscosity
  • Intra-operative use of antibiotics
  • Preventing bleeding into the bowel, or loss of blood supply for any extended length of time

Patients who are preparing for abdominal surgery should discuss what measures are being taken to minimize the chance of an abdominal adhesion forming after surgery.

If you have suffered with an abdominal adhesion in the past, please help the other members of the AbdoPain.com community by offering your valuable advice and insights. 

References:

  • Shichao Jiang,  Wei Wang,  Hede Yan, and Cunyi Fan.  Prevention of Intra-Abdominal Adhesion by Bi-Layer Electrospun Membrane. Int J Mol Sci. 2013 June; 14(6): 11861–11870. Published online 2013 June 4. doi:  10.3390/ijms140611861
  • Herington JL,Glore DR,Lucas JA,Osteen KG,Bruner-Tran KL. Dietary fish oil supplementation inhibits formation of endometriosis-associated adhesions in a chimeric mouse model. Fertility and sterility, 25 October 2012, 1556-5653
  • Erhan Aysan et al. New and Simple Approach for Preventing Postoperative Peritoneal Adhesions: Do not Touch the Peritoneum without Viscous Liquid—A Multivariate Analysis. Obstet Gynecol Int. 2012; 2012: 368924. Published online 2012 January 26. doi: 10.1155/2012/368924
  • Liakakos T et al. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg. 2001; 18(4):260-73.
  • Pelvic Pain: Diagnosis and Management. By Fred M. Howard, Paul Perry, James Carter, Ahmed M. El-Minawi (2000).
  • 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
  • Monk BJ et al. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol. 1994 May; 170(5 Pt 1):1396-403.

Abdominal Adhesions - Share Your Experience

Do you have a story about abdominal adhesions? Any question or comment? Share it!

Please feel free to contribute your thoughts here if you read postings by others, and you want to say something.

All postings are read by the abdominal pain team, and we shall respond to some queries directly on this page too.

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