Abdominal adhesions symptoms can occur when you least expect them. Find out what they are and how to treat them!
Abdominal adhesions are scar tissue that usually appear after surgery or a complication in this region. They occur after an inflammatory event in the organs and surfaces that are located in this region of the body. In particular, they are bands of scar tissue whose clinical manifestations can vary.
Sometimes they are asymptomatic, but in certain cases they are a trigger for abdominal pain. Abdominal discomfort, intestinal obstruction and female infertility are also quite common.
Its usual cause is usually the manipulation of the contents of these cavities during open surgeries. Still, there may be other risk factors such as certain diseases.
What are abdominal and pelvic adhesions?
As we have mentioned, abdominal and pelvic adhesions are bands of scar tissue, with the presence of blood vessels and nerves, between two surfaces. Often, it occurs from one intestinal loop to another (organ-organ) or from one intestinal loop to the abdominal wall.
This causes the surfaces to adhere to each other, which affects mobility. This usually occurs after a traumatic event or an inflammatory process that activates the mechanisms that lead to the repair of damaged tissue.
Associated inflammatory process
There is the release of substances that increase the permeability of blood vessels and of different inflammatory metabolites that act at the site with the release of abundant fibrin (a protein that generates networks between different tissues including blood vessels). Thus, to connect surfaces that should not be these bands appear.
Under normal conditions, visceral surfaces are smooth and slippery. In addition, between the handles there is a lubricating liquid that facilitates constant movement. The fact that there are these scar bands that adhere the tissues to each other, prevents the normal movement of the visceral contents of the abdominal cavity.
In particular, it does not allow adequate mobility of the loops of the small and large intestine, which can cause them to twist between each other and obstruct blood flow or intestinal transit. Similarly, they can affect the position of different organs, such as the uterus, where they attach to the ovaries and prevent ovulation.
Causes
Triggers for abdominal and pelvic adhesions can be non-traumatic (inflammatory, infectious or ischemic processes) or traumatic (surgical). Among these, the most frequent are those associated with surgical interventions.
The probability of developing pelvic adhesions can be up to 90% in open pelvic surgeries. It can also occur in cases of curettage or uterine curettage.
Meanwhile, in open abdominal surgeries the probabilities are a little lower, but they are still high, reaching up to 75%. Of these, the most common are those in which there is manipulation of the examination or of the gallbladder.
Other factors associated with these interruptions are the manipulation of organs and the possible incidental injury, either by the use of electrocautery, incisions, sutures or by foreign bodies left in the area.
Inflammatory diseases
The presence of some inflammatory diseases can lead to the development of these scar bands. Specifically, it occurs in the following pathologies:
- Endometriosis.
- Cancer.
- Crohn’s disease or ulcerative colitis.
- Appendicitis.
- Cholecystitis (inflammation of the gallbladder).
- Diverticulitis (inflamed sacs in the gastrointestinal tract).
- Pelvic inflammatory disease (chronic inflammation in the female sex organs).
- Inflammatory reaction to the placement of an intrauterine device (which generates adhesions within the uterine cavity).
Other causes
- Infections, especially those produced in surgical wounds or intestinal tuberculosis.
- Sexually transmitted diseases (such as chlamydia) that can cause pelvic inflammatory disease.
- Congenital adhesions due to malformations during the development of the peritoneal cavity.
- Radio and chemotherapy.
Abdominal adhesions symptoms
In many cases, abdominal and pelvic adhesions are asymptomatic. Thus, they are usually discovered even years after their appearance. However, there are those who do have complications, such as intestinal obstruction and female infertility.
In even more serious cases, they cause the death (ischemia) of the intestinal tissue, perforation of an organ or persistent intestinal obstruction. In general, its main manifestation is constant abdominal discomfort. Similarly, the following may occur:
- Progressive abdominal distension, infraumbilical, especially after food intake.
- Chronic pelvic pain, if there is pelvic involvement.
- Dyspareunia (pain during sex).
- Irregular menstruation.
- Intestinal obstruction.
It can manifest as progressive abdominal distention, severe abdominal pain, difficulty passing gas and evacuation, nausea, and vomiting.
Infertility
It occurs because the fallopian tubes and ovaries adhere to other surfaces. This affects the ability to release eggs, as well as their fertilization and the transfer of the fertilized egg to the uterine cavity.
Diagnosis
There is no imaging study that allows its exact identification, the only way to be certain is through open abdominal surgery (exploratory laparotomy) with direct visualization of abdominal or pelvic adhesions.
However, there are different imaging studies that make it possible to elucidate the presence of its most serious complication; intestinal obstruction. The most used tests are the following:
- Plain abdominal x-ray.
- Barium contrasted studies.
- Abdominal tomography.
- Pelvic with double contrast.
- Abdominal and pelvic ultrasound.
- X-ray of the intestine.
- Imaging tests help determine if there are serious complications such as intestinal obstruction.
Treatment and prevention of abdominal adhesions symptoms
According to a review published in the Annals of Medicine and Surgery, the treatment of adhesive disease can be delayed due to the difficulty in having a timely diagnosis. However, this is important to avoid complications.
The therapeutic option of choice is adherenciolysis or adhesion lysis. This procedure is performed during open abdominal surgery. There, the scar tissue that makes up the bands is cut to release the attached structures.
Abdominal and pelvic adhesions are cut with a scalpel, laser, or electrocautery (electrical current is used to burn and cut tissue). If the integrity of part of the organ’s tissue is compromised, then that particular area is resected.
Treatment is usually used if there is a bowel obstruction. When the involvement of the intestinal transit is minimal or the obstruction is partial, it is possible to start medical treatment without resorting to surgery. However, if there are complications, intervention will be necessary.
Expectant medical treatment basically consists of the following:
- An absolute diet.
- Placement of a nasogastric tube (tube from the nose to the stomach) to aid abdominal decompression.
- Administration of intravenous fluids to maintain fluid, electrolyte and fluid balance.
Prevention
Although adherenciolysis is very effective, there is the possibility of recurrence with new adhesions, which is why it is only performed in cases of severe intestinal obstruction or another complication such as infertility. In reality, there is no prevention method. However, proper and minimal handling is recommended during surgeries.
- Avoid invasive surgeries (use laparoscopy instead of open surgeries).
- Reduce the use of electrocautery, lasers, and spacers.
- Use the appropriate suture material.
- Keep the peritoneum moist during open surgeries.
- Wash the peritoneal cavity before closing it.
- Avoid leaving foreign bodies.
- Gently manipulate the organs.
At present, prevention has been considered through sterile and resorbable membranes that can be placed on the organs, such as non-stick barriers, gels with hyaluronic acid / carboxymethylcellulose or the use of anti-inflammatory drugs.
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