Bowel Adhesions Flashcards
What are adhesions?
Fibrous bands of scar tissue
What causes adhesions?
Many occur secondary to previous surgery or intra-abdominal inflammation (particularly pelvic), but may be congenital
What is the importance of adhesions?
One of the main causes of small-bowel obstruction, accounting for around 60% of cases, and also associated with female infertility and chronic pelvic pain
What are the clinical features of adhesions?
Generally asymptomatic, but the fact of adhesions that presents with clinical features
What effects of adhesions may present?
- Obstruction
- Infertility
- Chronic pelvic pain
What is much of the work up for suspected bowel adhesions directed at?
The subsequent pathology that has developed
What management should be attempted in those with uncomplicated bowel obstruction?
Conservative management
What is involved in the conservative management of uncomplicated bowel obstruction?
- Tube decompression
- NBM
- IV fluids
- Adequate analgesia
When is surgical intervention indicated for adhesional bowel obstruction?
In any patient with clinical features of ischaemia or perforation, or failed conservative treatment
What is the surgical intervention for adhesional bowel obstruction?
Adhesiolysis
What should adhesiolysis be limited to in adhesional bowel obstruction?
Only the adhesions causing mechanical obstruction
Why should adhesiolysis be limited to only those causing the obstruction?
To reduce the risk of recurrent adhesional disease
Describe the surgical approach to adhesiolysis?
Open management still performed in many causes, but laparoscopic management becoming the mainstay. Often technically challenging due to distention of the bowel, and therefore increased risk of iatrogenic injuries to the bowel. consequently should be low threshold to open approach in extensive disease
How are bowel adhesions prevented?
- Correct surgical technique
- Reduced intraperitoneal organ handling
