Adhesions are fibrous bands that form between tissues and organs, often from surgical injury. They can be known to be internal scar tissue that usually binds unconnected tissues.

Types

The most common cause of abdominal adhesions (or intra-abdominal adhesions) is abdominal surgical procedures. The adhesions begin to develop within hours of surgery and can cause internal organs to bind in the abdominal cavity to the surgical site or to other organs. Adhesive twisting and pulling of internal organs can lead to complications such as abdominal pain or bowel obstruction.

Small bowel obstruction (SBO) is a major consequence of postoperative adhesions. When an adhesion pulls or kinks the small intestine and prevents content from flowing through the digestive tract, an SBO may be cause.

Intra-abdominal adhesions may be congenital or acquired. Congenital adhesions arise during physiological organogenesis—like the frequently observed attachment of the sigmoid colon to the left pelvic wall—or can be traced back to abnormal embryonal development of the abdominal cavity. They are usually asymptomatic and are diagnosed incidentally.

Postmortem examination of patients who had not undergone surgery identified postinflammatory adhesions in 28% of cases. These are caused by intra-abdominal inflammation or can be attributed to endometriosis, peritonitis, radiotherapy, or long-term peritoneal dialysis

Diagnosis

Intra-abdominal adhesions are predominantly diagnosed intraoperatively. Careful history taking can substantiate the suspicion of adhesions; no other clinical investigations or imaging procedures enable a confident diagnosis. Evidence pointing to adhesions may be yielded by high-resolution ultrasonography and functional cine MRI, both of which detect limited movement relative to one another of organs joined by adhesions. However, neither of these modalities is established in routine clinical practice.

Complications of adhesions

The intra-abdominal adhesions that arise from the beginning of the surgical procedure can cause complications decades later. The patients’ symptoms include meteorism, irregular bowel movementsoder ist eher “variable stool consistency” gemeint?, chronic abdominal pain, digestive disorders, unwanted childlessness, and intestinal occlusions, and often fail to be associated with their cause. In contrast to congenital or postinflammatory adhesions, which are mostly asymptomatic, postoperative adhesions cause 40% of all cases of intestinal obstruction. Stenoses of the large intestine are produced principally by malignancies and only rarely by adhesions, but adhesions cause 65% to 75% of small bowel occlusions—the most serious of all adhesion-induced complications. Particularly colectomy, involving a large peritoneal incision, carries an 11% cumulative risk of ileus within the first year after operation.

Prevantions

Adhesions are an inevitable consequence of intra-abdominal surgery. They can be prevented to some extent with meticulous surgical technique and certain other measures. For operations carrying a high risk of postoperative adhesions, e.g., surgery on the adnexa or bowel, commercially available peritoneal instillates or barrier methods can be used to limit adhesion formation.

Clinical Gastroenterology Journal (formerly Journal of Colitis & Diverticulitis) is a peer reviewed, open access journal considering research on all aspects of digestive system, gastrointestinal diseases, liver, bilary tract, pancreas, diseases of related organs Ulcer medicine, Colitis, Diverticulitis and associated disorders and their treatment. The Journal aims to provide a platform for the exchange of scientific information addressing clinical research and practice of Gastroenterology and Hepatology.

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