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Adhesions Between Loops of Small Intestine

Adhesions Between Loops of Small Intestine

All surgery causes some scar tissue as part of the healing process. It's the same on the inside as it is on the outside. You may have heard about adhesions. Adhesions are filmy bands of scar tissue that may occur within the abdomen. They can develop in response to prior abdominal trauma or infection, but most often occur after abdominal surgery - often many years later. Adhesions themselves, like any form of scarring, are not harmful. In fact, most adhesions cause no symptoms at all.

The most serious complication is intestinal obstruction. Sometimes, adhesive bands will connect between two loops of small intestine. This may cause a kink to form in the small intestine and lead to a bowel blockage. Just like bending a garden hose stops the flow of water, a kink in the small intestine can block the flow of food in the digestive tract. Symptoms of a blockage of the small intestine would include crampy abdominal pain, distention of the abdomen, constipation, and vomiting. Neither x-ray studies nor scope tests can see adhesions, but x-rays can see the dilated loops of small intestine above the blockage. A blocked intestine is a medical emergency and requires hospitalization. Without treatment, severe dehydration and electrolyte imbalances occur. Eventually, the blocked intestine dies and develops gangrene and peritionitis which can be fatal. Minor episodes can be treated by withholding food for several days and inserting a tube down though the nose and into the stomach (NG or nasogastric tube) to pump out the stomach contents. If the blockage persists, exploratory surgery is needed to release the adhesive bands.

The other common complication of abdominal adhesions is pain. Since adhesions can develop between surfaces inside the abdomen which are not normally connected, they can tug and pull which may be felt as persistent adominal pain. As mentioned above, neither x-ray studies nor scope tests can see adhesions, so the diagnosis is difficult. In severe cases, surgery may be needed to make the diagnosis and lyse (cut) the fibrous bands. Unfortunately, since any abdominal surgery can lead to future adhesions, they are often recurrent.

Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved

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