Adhesions, Gastrointestinal (Abdominal Adhesions)

Abdominal Adhesions – Treatment Options

Introduction
Abdominal adhesions are bands of fibrous scar tissue that form between abdominal organs and tissues, often as a result of surgery, infection, inflammation, or trauma. While many adhesions remain asymptomatic, they can cause complications such as chronic abdominal pain, infertility, and small bowel obstruction. Management depends on whether the adhesions are symptomatic or causing life-threatening complications.

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1. Conservative Management (Asymptomatic or Mild Symptoms)

• Observation:

  • Most adhesions do not require treatment if they are not causing obstruction or significant pain.

• Symptom management:

  • Analgesics (acetaminophen, NSAIDs) for mild abdominal discomfort.

  • Dietary modification (low-fiber diet in partial obstruction) to reduce symptoms.

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2. Acute Adhesive Small Bowel Obstruction (SBO)

• Initial stabilization:

  • Nil per os (NPO – nothing by mouth).

  • IV fluid resuscitation with electrolyte correction.

  • Nasogastric tube decompression for vomiting and abdominal distension.

• Monitoring:

  • Serial abdominal examinations and imaging (CT, X-ray).

• Nonoperative management:

  • In partial obstruction without peritonitis, conservative therapy can be attempted for 24–72 hours.

• Surgical intervention:

  • Indicated if complete obstruction, peritonitis, bowel ischemia, or failure of conservative management.

  • Laparoscopic or open adhesiolysis performed.

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3. Chronic Pain and Recurrent Symptoms

• Pharmacologic:

  • Analgesics, antispasmodics.

• Non-pharmacologic:

  • Physiotherapy and gentle abdominal exercises to improve motility.

  • Psychological support (pain clinics, CBT) in chronic pain syndromes.

• Surgical adhesiolysis:

  • Considered only for severe, persistent, or obstructive symptoms, as surgery itself may cause new adhesions.

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4. Preventive Strategies (During Surgery)

• Minimally invasive techniques: Laparoscopic surgery reduces adhesion formation compared to open surgery.

• Gentle tissue handling: Reduced trauma and bleeding minimize adhesion risk.

• Use of adhesion barriers: Hyaluronic acid/carboxymethylcellulose sheets or icodextrin solution during surgery.

• Limiting unnecessary surgery: Avoiding repeated abdominal procedures when possible.

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5. Complication Management

• Infertility (tubal adhesions in women):

  • Laparoscopic adhesiolysis may improve fertility.

  • Assisted reproductive technologies (e.g., IVF) if adhesiolysis unsuccessful.

• Recurrent bowel obstruction:

  • May require repeat surgical intervention, though risk of new adhesions persists.

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6. Multidisciplinary Care

• Gastroenterologists: For diagnostic evaluation and non-surgical management.

• Surgeons: For adhesiolysis in obstruction or infertility-related cases.

• Pain specialists: For chronic abdominal pain management.

• Gynecologists: For fertility-related adhesions.

• Nutritionists: For dietary counseling in partial obstruction or malnutrition.