Adhesions

Question 1

What are bowel adhesions and what do they lead to?

Answer 1

Fibrous bands connecting parts of the bowel together.

Lead to small bowel obstruction

Question 2

What are clinical features of bowel adhesion?

Answer 2

Clinical features of bowel obstruction:
Abdominal pain
Vomiting
Abdominal distention
Absolute constipation
Palpate for localised tenderness or peritonism - abdo pain, tenderness, guarding exacerbated by moving peritoneum - forced cough, flexing one's hips, or eliciting the Blumberg sign (rebound tenderness - pressing a hadn't on the abdomen elicits less pain than releasing the hand abruptly which will aggravate) Rigidity  (involuntary contraction of abdominal muscles

Question 3

What is peritonism?

Answer 3

abdo pain, tenderness, guarding exacerbated by moving peritoneum - forced cough, flexing one’s hips, or eliciting the Blumberg sign (rebound tenderness - pressing a hadn’t on the abdomen elicits less pain than releasing the hand abruptly which will aggravate) Rigidity (involuntary contraction of abdominal muscles

Question 4

What investigation for bowel adhesions?

Answer 4

Routine bloods
G&S, crossmatch if surgical intervention likely
Monitor electrolytes for dehydration
VBG is signs of ischaemia or perforation
Imaging - AXR to assess for bowel obstruction
erect CXR off perforation is suspected
CT scan for further details

Question 5

What is a sensitive marker for bowel ischaemia?

Answer 5

Serum lactate

Question 6

What is management for bowel adhesions?

Answer 6

Conservative:
In patients with uncomplicated bowel obstruction
Tube decompression - passing NG tube into stomach and allowing any build up of pressure to be released
NBM
IV fluids
Analgesia
Correct fluid and electrolytes

Surgical:
Clinical features of ischaemia or perforation, worrying CT (intraperitoneal fluid/mesenteric oedema or ischaemia) or failed conservative management
Laparoscopic management for bowe adhesions - allows faster return of intestinal function, shorter stays, fear complications, decreased adhesion formation

Adhesiolysis limited to adhesions causing mechanical obstruction or strangulation

Question 7

How to prevent adhesion formation?

Answer 7

Correct surgical technique and reducing intraperitoneal organ handling