Saturday, January 24, 2015
Surgery can both cause and treat abdominal adhesions
DEAR DOCTOR K: I had abdominal surgery last year. Soon after, I started experiencing severe pain and swelling in my abdomen. It turns out I have abdominal adhesions. I’d never heard of them. What are they, and how are they treated?
DEAR READER: Abdominal adhesions are bands of fibrous scar tissue. They can cause organs that are normally not connected to stick to one another or to the wall of the abdomen.
Abdominal adhesions most commonly develop after abdominal surgery. Less often, adhesions form in people who develop an infection or other type of inflammation in the abdomen.
In most patients, adhesions do not cause any symptoms. In a small number of people, however, they do. Some people appear to inherit genes that make them more likely to form adhesions. Some are just unlucky: Adhesions form in a location that makes them more likely to pinch and block the intestines.
In any event, the fibrous bands of scar tissue can block the intestines either completely or partially. This blockage is called a bowel obstruction. It can cause cramping abdominal pain. Sometimes an area of intestine alternates between being blocked, then unblocked. As a result, symptoms come and go.
More significant intestinal obstruction can cause:
• severe, cramping abdominal pain;
• nausea and vomiting;
• swelling of the abdomen;
• inability to pass gas and absent or infrequent bowel movements;
• signs of dehydration. These include dry skin, dry mouth and tongue, severe thirst, infrequent urination, fast heart rate and low blood pressure.
Rarely, a portion of the bowel twists tightly around a band of adhesions. This cuts off the normal blood supply to the twisted bowel, causing “strangulation.” That section of bowel begins to die. When this emergency happens, immediate abdominal surgery is required to remove the adhesions and restore blood flow to the bowel.
During surgery, a surgeon removes as much as possible of the scar tissue causing the blockage. In performing the surgery, the surgeon often spots other adhesions besides the ones causing the blockage. The patient is already under anesthesia and the abdomen has been opened. Therefore, other adhesions also are removed to prevent them from causing trouble in the future. (I’ve put an illustration of surgery to remove adhesions on my website, AskDoctorK.com.)
So surgery is both a cause of, and a treatment for, abdominal adhesions. When surgery is done to remove an intestinal obstruction caused by adhesions, the surgery can cause adhesions to form again and create a new obstruction. Laparoscopic surgery, in which several small incisions are made instead of one large incision, can reduce the risk of abdominal adhesions.
So the surgeon’s decision on whether to perform surgery can be a complicated one. When adhesions are causing strangulation, however, it’s not complicated: Surgery is not only necessary, but often lifesaving.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.