Intestinal adhesions

Disease Description (Causes and Symptoms)

Intestinal adhesions are a condition in which tissues that should normally remain separate become connected by fibrous bands (adhesions) between the intestines, between the intestines and the peritoneum, or between the intestines and the mesentery. The main causes are intra-abdominal inflammation (peritonitis), rupture of an intra-abdominal organ, inflammatory bowel disease, ischemic bowel disease, and, most commonly, abdominal surgery (especially open surgery). Pathophysiologically, adhesions can interfere with intestinal movement or cause partial or complete obstruction of the intestinal tract, leading to ileus or mechanical obstruction and impaired blood flow (ischemia caused by volvulus or strangulation).

Main symptoms

• Abdominal pain (intermittent or persistent), abdominal distension
• Vomiting (sometimes persistent; bilious or non-bilious), loss of appetite
• Constipation or cessation of bowel movements and passage of gas
• Weight loss (in cases of chronic adhesions)
• Typical signs of intestinal ischemia and strangulation: acute persistent pain, fever, tachycardia, and signs of peritoneal irritation → emergency situation

Diagnostic aids (based on clinical judgment)

• Plain abdominal X-ray (standing or sitting): intestinal gas patterns (such as air-fluid levels)
• Abdominal CT (including contrast-enhanced CT): identification of the site of obstruction, the cause of obstruction, and bowel-wall findings (ischemia/necrosis)
• Small-bowel/large-bowel contrast study (if necessary)
• Blood tests: CBC (elevated white blood cell count), electrolytes, blood gas and lactate — important when ischemia is suspected

Treatment (Standard Treatment, Medications, Procedures/Surgery, Lifestyle Management, and Precautions)

Conservative treatment (attempted initially for non-peritonitic, partial obstruction)

• Fasting (NPO) and gastrointestinal decompression (nasogastric tube/Levin tube) to relieve vomiting and distension
• Intravenous fluids to correct dehydration and electrolyte abnormalities
• Antiemetics and pain control (non-opioid medications preferred); antibiotics are used when there are signs of infection, if necessary
• Observation period: typically observe for improvement within 24–72 hours (based on clinical and radiological assessment)

Surgical treatment (considered in the following cases)

• Complete obstruction, persistent worsening, signs of peritonitis, suspected intestinal ischemia or necrosis, or failure of conservative treatment
• Procedure: adhesiolysis; resection and anastomosis of necrotic bowel
• Approach: laparoscopy (when possible) or laparotomy — laparoscopy may reduce re-adhesion and shorten recovery, but the approach is selected according to the circumstances
• Preventive measures during surgery: consideration of using an adhesion barrier (e.g., hyaluronic acid–carboxymethylcellulose)

Precautions (Self-Care and Medical Considerations)

• If intestinal obstruction is suspected, avoid eating or taking medications and visit a medical institution immediately
• Immediate emergency evaluation is necessary in the presence of severe pain, fever, persistent vomiting, or failure to pass gas or stool
• Opioid analgesics should be used cautiously because they may further suppress intestinal motility
• Adhesions may recur even after surgery (depending on the report, the recurrence rate is approximately 10–15%)

Complications

• Intestinal obstruction, intestinal ischemia and necrosis (risk of perforation), sepsis, surgery-related complications (such as bleeding and infection), chronic pain, and reduced organ function

Prognosis

• Partial or mild adhesions may improve with conservative treatment
• Severe obstruction or intestinal ischemia can be life-threatening, and early diagnosis and treatment are critical to the prognosis
• Recurrence is possible (re-adhesion may occur even after surgery)

Checklist Before an Outpatient Visit (Items to Bring and Information to Record — Including Example Questions)

Items to bring

• List of currently used medications (including prescription medications, OTC medications, and supplements)
• Allergy history (including drug allergies)
• History of previous abdominal surgery (name and date of surgery), and history of abdominal infection or inflammation
• Recent test and imaging results (if available, bring the images or reports)
• Records of weight changes and bowel movements and passage of gas
• Timing and pattern of symptoms (when they began and what situations worsen or relieve them), and the characteristics of vomit (whether it is bilious)

Items useful to write down in advance for the visit (example questions)

• The time the pain began, its intensity, duration, and factors that relieve or worsen it
• Whether symptoms worsen after meals and any changes in the passage of stool or gas
• Whether there has been fever, chills, or changes in urination

General Examples of Questions to Ask the Doctor

• Based on my current symptoms (and test results), am I in a condition requiring emergency surgery?
• How likely is it that I will improve with conservative treatment? How long will the observation period be?
• If surgery is necessary, which method (laparoscopy vs. open surgery) do you recommend? What are the risks of complications?
• What preventive measures are taken during or after surgery to reduce the risk of recurrence?
• When can I return to my daily activities (eating, exercising, returning to work, etc.)?

Examples of Disease-Specific Questions

• I have undergone several abdominal surgeries in the past. What strategies (such as the surgical approach or use of an adhesion barrier) are recommended to reduce the risk of recurrent adhesions during repeat surgery?
• An obstruction site is suspected on CT. What additional tests are needed (such as a small-bowel contrast study), and what are the advantages and disadvantages of each test?

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Note: The information above is a description based on general clinical guidelines and the provided clinical summary. Since diagnosis and treatment plans may vary depending on the individual’s condition, please consult the treating medical team for a specific evaluation.