Intestinal Adhesions After Abdominal Surgery

Introduction

Intestinal adhesions after abdominal surgery are surgical complications that can occur from days to years after surgery. Symptoms vary depending on the degree of intestinal adhesions, but the cause is that part of the intestine is partially blocked and the flow of contents in the intestine is inhibited. If it is left untreated initially, it may be necessary to reoperate to eliminate the cause.

Definition

Around the intestine is the peritoneum that surrounds it. If the surgeon touches the intestine during surgery, the membrane is damaged and inflammation begins. In this state, over time, the intestines stick to each other, or the intestines and the abdominal wall are entangled. This is called intestinal adhesion. This is a normal form of wound healing and mostly does not cause symptoms. However, depending on the degree of intestinal adhesions, the intestinal tract may be partially or completely blocked, causing intestinal obstruction through which the intestinal contents cannot pass.

Cause

During abdominal surgery, tissue in the abdominal cavity, such as the peritoneum, intestine, and mesentery, is damaged. The damaged area then heals, causing inflammation and fibrosis. Just after surgery, scars form on the abdominal cavity after surgery, and intestinal adhesions occur here. Intestinal adhesions can occur in all types of abdominal surgery, but the greater the range of surgery and the more damage, the better. In addition, if the hematoma that occurred during surgery remains in the abdominal cavity without being removed cleanly, the hematoma can harden to form a tight band, thereby causing intestinal adhesions.

Symptom

Intestinal adhesions that occur after abdominal surgery are complications that can occur to anyone who has had surgery. Most of the patients have no other symptoms. Therefore, the intestinal adhesion itself is not a problem, but rather an intestinal obstruction in which intestinal adhesions block the flow of intestinal contents. When intestinal obstruction occurs, symptoms such as cramping abdominal pain, nausea and vomiting, and bloating may occur. If intestinal obstruction persists, symptoms such as dehydration, tachycardia, and low blood pressure may occur with imbalance of moisture and electrolyte.

Particularly in case of severe intestinal obstruction, the intestine in the upper part of the obstruction moves excessively to overcome the flow of blocked intestinal contents, which can cause severe abdominal pain. Abdominal pain may last for minutes or hours, but it may go away on its own, but it may be lost after visiting the hospital emergency room, inserting a nasogastric tube, and removing the intestinal contents.

When a part of the intestine is tightened by an adhesion band in the abdominal cavity, blood supply to the intestine is blocked, which may cause ischemia. At this time, if rapid surgical treatment is not performed within a few hours, symptoms of peritonitis due to intestinal necrosis may occur. Because of this, the patient may develop sepsis, and may eventually die.

Patients may experience symptoms due to intestinal adhesions or intestinal obstruction even after relatively small surgery such as appendectomy, and on the contrary, they may be diagnosed as intestinal obstruction due to intestinal adhesions due to sudden abdominal pain and vomiting after decades of no symptoms.

Diagnosis

If the patient complains of digestive disorders at any time after abdominal surgery, partial intestinal obstruction due to intestinal adhesions should be suspected. If the patient is unable to discharge gas in the intestine and complains of nausea and vomiting, that alone can be diagnosed.

In addition, intestinal obstruction can be diagnosed in the form of gas shadow in the intestine through simple abdominal radiography. Chronic obstruction and repeated communication may be diagnosed by small bowel angiography or colon angiography, or abdominal computed tomography (CT).

Treatments

1) Consevative treatment

If intestinal obstruction is suspected, the most important treatment is fasting. In addition, when vomiting is accompanied, the moisture and electrolyte contained in the stomach contents are lost without being absorbed, resulting in dehydration and changes in the electrolyte in the body fluids.

Partial intestinal obstruction due to intestinal adhesions is mostly treated by fasting and decompression through a nasogastric tube insertion reaching the stomach.

2) Surgical treatment

If chronic intestinal obstruction symptoms are repeated, or abdominal pain persists for hours, or if conservative treatment for 3-5 days does not resolve, surgery to remove the intestine may be necessary.