Intestinal Adhesions
Scar-like tissue bands that can bind the intestines
Quick Facts
- Type: Internal scar tissue (digestive)
- Most common cause: Previous abdominal or pelvic surgery
- Main risk: Bowel obstruction
- Often: Cause no symptoms at all
Overview
Intestinal adhesions are bands of fibrous, scar-like tissue that form between loops of the intestine or between the intestine and other organs or the abdominal wall. Normally, the surfaces inside the abdomen are smooth and slide easily past one another. Adhesions can cause tissues that are usually separate to stick together.
Adhesions most often develop after abdominal or pelvic surgery as part of healing. Many cause no problems and are never noticed. In some people, however, they lead to chronic pain or can pull or kink the intestine, causing a blockage (bowel obstruction), which can be a medical emergency.
Symptoms
Many adhesions cause no symptoms. When they do, the main issues are pain and bowel obstruction. Signs may include:
- Crampy abdominal pain that comes and goes
- Bloating and abdominal swelling
- Nausea and vomiting
- Constipation or inability to pass gas or stool
- Loud bowel sounds early on
A complete bowel obstruction is an emergency. Severe abdominal pain, persistent vomiting, a swollen abdomen, and inability to pass gas or stool require immediate medical care, as a trapped or strangulated loop of bowel can lose its blood supply.
Causes
Adhesions form as part of the body's healing response when tissues inside the abdomen are irritated or injured. Causes include:
- Surgery: The most common cause; handling, cutting, or drying of tissues during abdominal or pelvic operations.
- Inflammation and infection: Conditions such as appendicitis, diverticulitis, or pelvic infections.
- Inflammatory bowel disease: Ongoing inflammation in the intestines.
- Radiation therapy to the abdomen or pelvis.
Rarely, adhesions are present from birth. The likelihood of forming adhesions varies from person to person.
Risk Factors
- Previous abdominal or pelvic surgery, especially open (non-laparoscopic) operations
- Multiple prior surgeries
- Abdominal infections such as peritonitis
- Inflammatory bowel disease or endometriosis
- Radiation treatment to the abdomen or pelvis
Diagnosis
Adhesions themselves usually cannot be seen on standard imaging, which makes them difficult to diagnose directly. Doctors often suspect adhesions based on symptoms and a history of prior abdominal surgery or infection.
When a bowel obstruction is suspected, X-rays, CT scans, or other imaging help confirm the blockage and assess its severity. In some cases, adhesions are found and treated during surgery (laparoscopy) performed to relieve symptoms.
Treatment
Treatment depends on whether adhesions are causing symptoms:
- No symptoms: Adhesions found incidentally usually need no treatment.
- Partial obstruction: Often managed without surgery, using bowel rest (nothing by mouth), fluids through a vein, and sometimes a tube to relieve pressure, allowing the blockage to resolve.
- Complete or strangulated obstruction: Requires emergency surgery to free the trapped bowel and remove any damaged tissue.
- Surgery to remove adhesions (adhesiolysis): Can relieve obstruction or pain, though surgery itself may lead to new adhesions over time.
Prevention
Adhesions cannot always be prevented, but several measures may reduce the risk during surgery:
- Using minimally invasive (laparoscopic) techniques when possible
- Gentle tissue handling and keeping tissues moist during surgery
- Using special barrier products in selected operations to reduce adhesion formation
For patients, the main step is recognizing warning signs of obstruction early and seeking prompt care.
When to See a Doctor
See a doctor for recurring crampy abdominal pain or digestive problems, especially after previous abdominal surgery.
Seek emergency care immediately for signs of a bowel obstruction: severe or worsening abdominal pain, a swollen, tender abdomen, persistent vomiting, and inability to pass gas or have a bowel movement. A complete obstruction can cut off blood flow to the bowel and is a surgical emergency.
Frequently Asked Questions
What causes intestinal adhesions?
The most common cause is previous abdominal or pelvic surgery, as adhesions form during healing. Inflammation, infections such as appendicitis or diverticulitis, inflammatory bowel disease, endometriosis, and radiation therapy can also cause them.
Do adhesions always cause symptoms?
No. Many adhesions cause no problems and are never noticed. Some people develop chronic abdominal pain or, more seriously, a bowel obstruction when adhesions kink or trap a loop of intestine.
When are intestinal adhesions an emergency?
They become an emergency when they cause a complete bowel obstruction. Severe abdominal pain, persistent vomiting, a swollen abdomen, and inability to pass gas or stool require immediate care, since trapped bowel can lose its blood supply.
Can adhesions be removed?
Yes, with surgery called adhesiolysis, which can relieve obstruction or pain. However, surgery itself can trigger new adhesions, so the decision to operate weighs the benefits against this risk.
Can adhesions be seen on a scan?
Usually not directly. Adhesions themselves are hard to see on standard imaging. Doctors suspect them from symptoms and surgical history, and scans are mainly used to detect a resulting bowel obstruction.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Abdominal Adhesions.
- MedlinePlus, U.S. National Library of Medicine. Intestinal obstruction and adhesions.
- Cleveland Clinic. Abdominal Adhesions.
- American College of Surgeons.