From the Guidelines
The primary cause of intestinal (bowel) adhesions is adhesions, which account for 60-75% of small bowel obstructions, even in patients with no prior abdominal surgery, also known as virgin abdomen. Adhesions are abnormal bands of scar tissue that form between tissues and organs, causing them to stick together. According to a recent study published in the World Journal of Emergency Surgery 1, adhesions are the single most common cause of small bowel obstruction (SBO), accounting for 60-75% of cases. Another study published in the same journal 1 found that adhesions were the cause of bowel obstruction in 47.9% of cases of SBO-VA (small bowel obstruction in virgin abdomen).
Key Points
- Adhesions are the primary cause of intestinal (bowel) adhesions, accounting for 60-75% of small bowel obstructions 1
- Adhesions can occur even in patients with no prior abdominal surgery, also known as virgin abdomen 1
- The origin of adhesions in the virgin abdomen can be congenital, or the result of (unrecognized) abdominal inflammation in the patient's history 1
- Other less common causes of bowel adhesions include inflammation from conditions like endometriosis, pelvic inflammatory disease, or abdominal infections such as peritonitis, as well as radiation therapy to the abdomen 1
Implications for Treatment
- The fact that adhesions are the primary cause of bowel obstructions, even in patients with no prior abdominal surgery, has important implications for treatment 1
- Guidelines on the management of adhesion-related small bowel obstruction (ASBO) may also apply to the majority of patients with SBO-VA 1
- Patients who have had abdominal surgery or have a history of abdominal inflammation should be aware of symptoms like intermittent crampy abdominal pain, nausea, vomiting, or signs of bowel obstruction, which might indicate problematic adhesions requiring medical attention 1
From the Research
Primary Cause of Intestinal Adhesions
The primary cause of intestinal (bowel) adhesions is abdominal surgery, which leads to the formation of adhesions as part of the normal healing process after damage to the peritoneum 2.
Key Factors Contributing to Adhesion Formation
- The early balance between fibrin deposition and degradation seems to be the critical factor in adhesion formation 2
- Peritoneal trauma during surgery can lead to adhesion formation, with laparoscopy producing less peritoneal trauma than conventional laparotomy 3
- Adhesions can develop after nearly every abdominal surgery, commonly causing female infertility, chronic pelvic pain, and small bowel obstruction 4
Prevalence and Complications of Adhesions
- Adhesions develop in 70-90% of patients undergoing abdominal surgery 5
- Adhesions can cause significant morbidity, including adhesive small bowel obstruction, infertility, and increased difficulty with reoperative surgery 2
- Adhesive small bowel obstruction is a major complication of adhesions, resulting in hospital readmissions and reoperation in 30-50% of cases 5, 6