Abdominal Adhesions

Overview

Abdominal adhesions are bands of fibrous scar tissue that form between abdominal organs and tissues, often after surgery, infection, trauma, or inflammation. They may cause no symptoms but can lead to chronic abdominal pain, infertility (in women, due to tubal blockage), or intestinal obstruction.

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Treatment Options

1. Conservative/Non-Drug Management

• Asymptomatic cases: No treatment required.

• Mild abdominal pain: Managed with reassurance, dietary modification (low-residue diet), and periodic monitoring.

2. Pharmacological Therapy (Symptom Control)

• Analgesics:

  • Paracetamol (acetaminophen): 500–1000 mg PO every 6–8 hours (max 4 g/day).

  • NSAIDs (e.g., ibuprofen 400 mg PO q8h) for inflammation-related pain.

• Antispasmodics (if bowel spasm-related pain):

  • Hyoscine butylbromide: 10–20 mg PO TID as needed.

  • Dicyclomine: 10–20 mg PO every 6–8 hours as needed.

• Laxatives (for associated constipation):

  • Lactulose: 15–30 mL PO daily, titrated.

  • Polyethylene glycol (PEG 3350): 17 g dissolved in water once daily.

3. Surgical Management

• Adhesiolysis (laparoscopic or open):

  • Indicated for recurrent small bowel obstruction, severe chronic pain, or infertility related to adhesions.

  • Minimally invasive (laparoscopic) approach preferred when possible.

• Preventive measures in surgery:

  • Use of barrier agents (e.g., hyaluronic acid–carboxymethylcellulose membrane) during surgery.

  • Gentle tissue handling and minimizing peritoneal injury.

4. Supportive & Lifestyle Measures

• Maintain hydration and balanced diet.

• Frequent small meals if partial obstruction suspected.

• Avoid foods that worsen bloating or constipation.

• Long-term follow-up in patients with prior bowel obstruction.

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Key Notes

• No effective medication exists to dissolve adhesions; treatment is mainly supportive or surgical.

• Most adhesions are clinically silent; intervention is only needed when complications occur.

• In women with infertility, laparoscopic adhesiolysis may improve conception chances.

• Re-formation of adhesions after surgery is common, so prevention during the first surgery is crucial.