What are intestinal adhesions?

Intestinal adhesions are the binding of the intestine, often with scar tissue from surgery or diseases such as endometriosis or Crohn's disease, which can create serious problems with intestinal function or risk to intestinal integrity. Although most people only develop minor adhesions after any type of intestinal surgery that does not present any risk, sometimes the union is significant and causes a partial or complete intestinal blockage. When this occurs, additional surgery or treatment may be necessary to remove adhesions or repair blockages.

The small and large intestines are complex structures that overlap each other in various ways. When surgery is performed or if scarring occurs within these structures, there is a potential for intestinal adhesions to form. Parts of the intestine can connect to each other through scar tissue, or in conditions such as endometriosis, endometrial tissue connects to parts of the intestine, particularly common in the upper intestine. Due to the way the intestines are structured, it is not that difficult for the scars to join together, partially obstructing the movement of food and liquids.

When intestinal adhesions are significant, they can cause total obstruction, resulting in severe abdominal and sometimes pelvic pain, inability to defecate, nausea or vomiting, fever, and potentially intestinal perforation. The latter is a great risk because the contents of the intestine can spill into the abdominal cavity and cause systemic infection. Suspected intestinal rupture or perforation is medically urgent, and the other symptoms described above also need immediate treatment.

Given the risks of intestinal perforation, doctors often take claims of intestinal adhesions or obstructions very seriously. To investigate this matter, a number of scans may be done, including computed tomography (CT) or magnetic resonance imaging (MRI). More extensive tests might include colonoscopy or barium x-rays to look for specific areas of intestinal adhesions or blockages.

People undergoing intestinal surgery of any kind are generally cautioned to be on the lookout for evidence of intestinal adhesions, although in the early stages there may be few symptoms of their presence. They can only become problematic if they start to block bowel function at a later time, and adhesions can take a while to develop after surgery. Those with chronic intestinal conditions or with endometriosis may also be warned that scarring in the intestines can lead to intestinal adhesions.

When adhesions are problematic and threaten or already obstruct the intestine, the standard of care is to remove them surgically. Those with significant scarring from Crohn's disease may simply develop more scarring from surgery and end up needing repeated bowel resections to manage this condition. Some doctors believe that non-surgical Crohn's approaches are best for as long as possible to avoid this slippery slope.

Each case is highly individualized. For some, surgical treatment to remove adhesions is the appropriate course. Surgery is definitely necessary for complete blockage or perforation of the intestine, as without it, these conditions can be fatal.

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