Bowel Adhesions Flashcards
What are bowel adhesions? And what causes them?
Adhesions are fibrous bands of scar tissue. Many occur secondary to previous surgery or intra-abdominal inflammation (particularly pelvic), however they can also be congenital.
What can bowel adhesions lead to?
They are one of the main causes of small bowel obstruction, accounting for around 60% of cases, and are also associated with female infertility and chronic pelvic pain.
What are the clinical features of bowel adhesions?
It is important to note that adhesions themselves are generally asymptomatic. Rather, it is the effect of the adhesions that present with clinical features (such as that of obstruction, infertility, or chronic pelvic pain).
What investigations should be ordered for bowel adhesions?
Much of the work-up required for suspected bowel adhesions is directed to that of the subsequent pathology that has developed.
Briefly describe the conservative management of bowel adhesions
For those in uncomplicated bowel obstruction, conservative management should be attempted initially, the mainstay of which is tube decompression.
Additionally, the patient should be kept nil-by-mouth, prescribed intravenous fluids, and provided with adequate analgesia.
Briefly describe the surgical management of bowel adhesions
Surgical intervention in adhesional bowel obstruction is warranted in any patient with clinical features of ischaemia or perforation or failed conservative treatment.
Adhesiolysis should be limited to only the adhesions causing the mechanical obstruction or strangulation, in an aim to reduce risk of recurrent adhesional disease.
Whilst open management is still performed in many cases, laparoscopic management for bowel adhesions is becoming the mainstay, due to improved post-operative outcomes. Often technically challenging due to the distension of the bowel (and therefore increased risk of iatrogenic injuries to the bowel), consequently there should be a low threshold for conversion to open approach in extensive disease.
How can bowel adhesion risk be prevented?
There are no devices currently able to totally prevent adhesion formation after abdominal surgery. Correct surgical technical and reducing intraperitoneal organ handling remain the mainstay of reducing bowel adhesion formation.
