Abdominal adhesions: what can happen years after surgery

Much has been talked about and complex surgeries. A case of public repercussion that illustrates this condition well is that of the former president, who has gone through several Abdominal. Since then, it has had multiple episodes of intestinal obstruction related to adhesion formation, and has been hospitalized several times for clinical and surgical treatment. This is a real example of the possible late consequences of adhesions.

What are abdominal adhesions

The adhesions are tracks of scar tissue that form within the abdomen, connecting organs that would normally not be connected. They arise after membrane inflammation or lesions that coat the abdominal organs called peritoneum. These fibrous “bridges” make it difficult to move the organs and, in more severe cases, can lead to intestinal obstruction.

The main cause of adhesions is abdominal surgeries, especially when involving blood, feces or pus contamination. It is estimated that up to 93% of patients passing through laparotomies develop some kind of grip. Other causes include infections (such as appendicitis and peritonitis), pelvic inflammatory diseases, endometriosis and abdominal trauma.

When the situation gets worse: encapsulating peritonitis

In rare situations, inflammation can lead to the formation of a thick fibrous capsule that surrounds the small intestine, a condition called encapsulating peritonitis. This “packaging” of the intestine prevents their movements, causing recurring intestinal obstructions and requiring specialized medical attention.

Symptoms and risks of adhesions

Simple adhesions may be asymptomatic, but when they compromise organ functioning, they cause symptoms such as:

• chronic or intermittent abdominal pain
• distension and discomfort after meals
• constipation
• nausea, vomiting and intestinal obstruction
• difficulty getting pregnant (in the case of pelvic adhesions)
• weight loss and malnutrition

Complications include recurrent intestinal obstructions, infections, intestinal ischemia and need for complex reoperations involving high risks, including death, in extreme cases.

Treatment Options

In light cases, treatment is clinical, with pain control, food adjustments, laxative use, anti-inflammatory drugs and nutritional monitoring. In severe cases, with obstruction or risk of drilling, surgery is required. The procedure, called adhesolis, seeks to release adhesions or, in the encapsulating peritonitis, remove the capsule that surrounds the . However, this type of surgery is challenging and of high risk as there are chances to injure organs involved.

Conclusion

Abdominal adhesions are common after surgical procedures and, in many cases, do not cause symptoms. But when they cause obstructions or severe pain, they require careful medical evaluation. The encapsulating, although rare peritonitis, represents a more severe degree of the inflammatory reaction and requires Specialized treatment. The key to success in managing these conditions is early diagnosis and the performance of experienced surgeons in digestive diseases.

Scientific sources used

1. Ellis H et al. “The cause and prevention of postoperative intraperitoneal adhesions.” Ann R Coll Surg Engl. 1999;81(1):11–18.

2. Vrijland WW et al. “Reduction of adhesion formation after open abdominal surgery: a prospective randomized multicenter trial.” Lancet. 2003;361(9365):1247–1251.

3. Habib AM et al. “Encapsulating peritoneal sclerosis: a rare cause of intestinal obstruction.” J Gastrointest Surg. 2006;10(7):1040–1044.

4. Parker MC et al. “Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery.” Arch Surg. 2001;136(12):1401–1406.

5. DiZerega GS. “Peritoneal surgery.” Springer-Verlag, 1999. Cap. 4: Pathophysiology of peritoneal adhesions, p. 47-66.

6. Sulaiman H et al. “Pathogenesis of peritoneal adhesions.” Pediatr Surg Int. 2001;17(4):292–296.

*By Antonio Couceiro Lopes (CRM 100656 SP | RQE 26013)
Digestive Surgeon