Abdominal Adhesions

National Digestive Diseases Information Clearinghouse

What are abdominal adhesions? Abdominal adhesions are bands of fibrous tissue that can form between abdominal tissues and organs. Normally, internal tissues and organs have slippery surfaces, preventing them from sticking together as the body moves. However, abdominal adhesions cause tissues and organs in the abdominal Stomach cavity to stick together. Large What is the abdominal intestine cavity? The abdominal cavity is the internal area of the body between the chest and Small hips that contains the lower part of the intestine esophagus, stomach, , and . The esophagus carries food and liquids from the mouth to the stomach, which slowly pumps them into the small and large intestines. Abdominal adhesions can kink, twist, or pull the small and large Adhesion intestines out of place, causing an intestinal obstruction. Intestinal obstruction, also called a , results in the partial or complete blockage of movement of Abdominal adhesions are bands of fibrous tissue that food or stool through the intestines. can form between abdominal tissues and organs. What causes abdominal How common are abdominal adhesions? adhesions and who is at risk? Abdominal is the most frequent Of patients who undergo abdominal cause of abdominal adhesions. Surgery- surgery, 93 percent develop abdominal related causes include adhesions.1 Surgery in the lower abdomen and , including bowel and gynecological • cuts involving internal organs operations, carries an even greater chance of • handling of internal organs abdominal adhesions. Abdominal adhesions can become larger and tighter as time passes, • drying out of internal organs and tissues sometimes causing problems years after • contact of internal tissues with foreign surgery. materials, such as gauze, surgical gloves, and stitches What are the symptoms of • blood or blood clots that were not abdominal adhesions? rinsed away during surgery In most cases, abdominal adhesions do Abdominal adhesions can also result not cause symptoms. When symptoms are from not related to surgery, present, chronic is the most including common. • rupture • radiation treatment What are the complications • gynecological infections of abdominal adhesions? Abdominal adhesions can cause intestinal • abdominal infections obstruction and —the Rarely, abdominal adhesions form without inability to become pregnant after a year of apparent cause. trying. Abdominal adhesions can lead to female infertility by preventing fertilized eggs from reaching the , where fetal development takes place. Women with abdominal adhesions in or around their fallopian tubes have an increased chance of ectopic pregnancy—a fertilized egg growing outside the uterus. Abdominal adhesions inside the uterus may result in repeated miscarriages—a pregnancy failure before 20 weeks.

1Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91–111. 2 Abdominal Adhesions How are abdominal Seek Help for Emergency adhesions and intestinal Symptoms obstructions diagnosed? A complete intestinal obstruction is life Abdominal adhesions cannot be detected threatening and requires immediate by tests or seen through imaging medical attention and often surgery. techniques such as x rays or ultrasound. Symptoms of an intestinal obstruction Most abdominal adhesions are found include during surgery performed to examine the • severe abdominal pain or cramping abdomen. However, abdominal x rays, a lower gastrointestinal (GI) series, and • computerized tomography (CT) scans can • vomiting diagnose intestinal obstructions. • bloating • Abdominal x rays use a small amount of radiation to create an image that is

• loud bowel sounds recorded on film or a computer. An • abdominal swelling x ray is performed at a hospital or an outpatient center by an x-ray technician, • the inability to have a bowel and the images are interpreted by a movement or pass gas radiologist—a doctor who specializes • —a condition in which in medical imaging. An x ray does not a person has fewer than three require anesthesia. The person will bowel movements a week; the lie on a table or stand during the x ray. bowel movements may be painful The x-ray machine is positioned over A person with these symptoms should the abdominal area. The person will seek medical attention immediately. hold his or her breath as the picture is taken so that the picture will not be blurry. The person may be asked to change position for additional pictures. • A lower GI series is an x-ray exam that is used to look at the large intestine. The test is performed at a hospital or an outpatient center by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. The health care provider may provide written bowel prep instructions to follow at home before the test. The person may be asked to follow a clear liquid diet for 1 to 3 days before the

3 Abdominal Adhesions procedure. A laxative or an enema How can abdominal may be used before the test. A laxative is medication that loosens stool and adhesions be prevented? increases bowel movements. An enema Abdominal adhesions are difficult to prevent; involves flushing water or laxative into however, certain surgical techniques can the using a special squirt bottle. minimize abdominal adhesions. For the test, the person will lie on a Laparoscopic surgery decreases the potential table while the radiologist inserts a for abdominal adhesions because several tiny flexible tube into the person’s anus. incisions are made in the lower abdomen The large intestine is filled with barium, instead of one large incision. The surgeon making signs of underlying problems inserts a laparoscope—a thin tube with a show up more clearly on x rays. tiny video camera attached—into one of the small incisions. The camera sends a • CT scans use a combination of x rays magnified image from inside the body to a and computer technology to create video monitor. Patients will usually receive images. The procedure is performed general anesthesia during this surgery. at a hospital or an outpatient center by an x-ray technician, and the images are If laparoscopic surgery is not possible and a interpreted by a radiologist. Anesthesia large abdominal incision is required, at the is not needed. A CT scan may include end of surgery a special filmlike material the injection of a special dye, called can be inserted between organs or between contrast medium. The person will lie on the organs and the abdominal incision. The a table that slides into a tunnel-shaped filmlike material, which looks similar to wax device where the x rays are taken. paper and is absorbed by the body in about a week, hydrates organs to help prevent How are abdominal abdominal adhesions. adhesions and intestinal Other steps taken during surgery to reduce obstructions treated? abdominal adhesions include Abdominal adhesions that do not cause • using starch- and latex-free gloves symptoms generally do not require • handling tissues and organs gently treatment. Surgery is the only way to treat abdominal adhesions that cause pain, • shortening surgery time intestinal obstruction, or fertility problems. • using moistened drapes and swabs More surgery, however, carries the risk of additional abdominal adhesions. People • occasionally applying saline solution should speak with their health care provider about the best way to treat their abdominal Eating, Diet, and Nutrition adhesions. Researchers have not found that eating, Complete intestinal obstructions usually diet, and nutrition play a role in causing or require immediate surgery to clear preventing abdominal adhesions. A person the blockage. Most partial intestinal with a partial intestinal obstruction may obstructions can be managed without relieve symptoms with a liquid or low-fiber surgery. diet, which is more easily broken down into smaller particles by the digestive system.

4 Abdominal Adhesions Hope through Research Points to Remember The National Institute of Diabetes and • Abdominal adhesions are bands Digestive and Kidney Diseases (NIDDK) of fibrous tissue that can form conducts and supports basic and clinical between abdominal tissues and research into many digestive disorders. organs. Abdominal adhesions Clinical trials are research studies involving cause tissues and organs in the people. Clinical trials look at safe and abdominal cavity to stick together. effective new ways to prevent, detect, or • is the most treat disease. Researchers also use clinical frequent cause of abdominal trials to look at other aspects of care, such adhesions. Of patients who as improving the quality of life for people undergo abdominal surgery, with chronic illnesses. To learn more about 93 percent develop abdominal clinical trials, why they matter, and how to adhesions. participate, visit the NIH Clinical Research Trials and You website at www.nih.gov/health/ • In most cases, abdominal adhesions clinicaltrials. For information about current do not cause symptoms. When studies, visit www.ClinicalTrials.gov. symptoms are present, chronic abdominal pain is the most common. For More Information • A complete intestinal obstruction American College of is life threatening and requires 6400 Goldsboro Road, Suite 200 immediate medical attention and Bethesda, MD 20817–5846 often surgery. Phone: 301–263–9000 Email: [email protected] • Abdominal adhesions cannot Internet: www.gi.org be detected by tests or seen through imaging techniques International Foundation for Functional such as x rays or ultrasound. Gastrointestinal Disorders However, abdominal x rays, a 700 West Virginia Street, Suite 201 lower gastrointestinal (GI) series, Milwaukee, WI 53204 and computerized tomography Phone: 1–888–964–2001 or 414–964–1799 (CT) scans can diagnose intestinal Fax: 414–964–7176 obstructions. Email: [email protected] Internet: www.iffgd.org • Surgery is the only way to treat abdominal adhesions that cause pain, intestinal obstruction, or fertility problems.

5 Abdominal Adhesions Acknowledgments National Digestive Diseases Publications produced by the Clearinghouse Information Clearinghouse are carefully reviewed by both NIDDK 2 Information Way scientists and outside experts. This Bethesda, MD 20892–3570 publication was originally reviewed by Phone: 1–800–891–5389 James M. Becker, M.D., F.A.C.S., Boston TTY: 1–866–569–1162 University School of Medicine; Arthur F. Fax: 703–738–4929 Stucchi, Ph.D., Boston University School of Email: [email protected] Medicine; and Karen L. Reed, Ph.D., Boston Internet: www.digestive.niddk.nih.gov University School of Medicine. The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the You may also find additional information about this National Institute of Diabetes and Digestive topic by visiting MedlinePlus at www.medlineplus.gov. and Kidney Diseases (NIDDK). The This publication may contain information about NIDDK is part of the National Institutes of medications and, when taken as prescribed, Health of the U.S. Department of Health the conditions they treat. When prepared, this publication included the most current information and Human Services. Established in 1980, available. For updates or for questions about the Clearinghouse provides information any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA about digestive diseases to people with (1–888–463–6332) or visit www.fda.gov. Consult your digestive disorders and to their families, health care provider for more information. health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

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NIH Publication No. 13–5037 September 2013

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