Symptoms and treatment of intestinal adhesions
Intestinal adhesions are formations of connective tissue (cords) between the abdominal organs and the intestinal loops, leading to the adhesion or adhesion of the serous membranes of the organs to each other. As a result, they are spliced together, which entails a wide variety of functional disorders. The strands themselves consist of the same tissue as the outer wall of the intestine. Most often, this pathological process is caused by the previous surgical intervention.
According to statistics, if a primary laparotomy intervention was performed on the intestine, then adhesions will form in 14% of cases, and if this is the third operation, then they occur in 96% of cases.
Content:
- Causes of intestinal adhesions
- Intestinal adhesions symptoms
- Diagnosis of intestinal adhesions
- Can a colonoscopy be done?
- How to treat intestinal adhesions?
Causes of intestinal adhesions
To determine the causes of intestinal adhesions, you need to understand the mechanism of their occurrence. It is known that all organs located in the abdominal cavity, including the intestines, are covered with thin sheets of the peritoneum. These sheets are smooth and produce little fluid that allows the intestines to move. When there is an effect of one factor or another on the intestine, this leads to the formation of its edema and the formation of fibrin plaque on the sheets of the peritoneum. This plaque has a sticky consistency and encourages adjacent tissues to bond to each other. If there is no adequate treatment at a given time, then at the place where there was inflammation and adhesion occurred, adhesions will form.
They do not form instantly, but go through several stages. First, fibrin appears, after 2 days it acquires fibroblasts that secrete collagen. On the 7th day, the inflamed tissues begin to be replaced by connective tissues. This process ends after 3 weeks. This time is enough for the formed adhesions to turn into adhesions. Later, nerves and capillaries grow in them.
The causes of intestinal adhesions are due to the following factors:
- The primary reason for the formation of intestinal adhesions is surgical manipulation of the organ. This can be an operation to remove appendicitis, a cesarean section, an operation to remove a polyp or other neoplasm. That is, any internal inflammation of the intestine, which ended with surgery, can lead to the formation of strands. Against the background of infection, inflammation, when the peritoneum dries out during surgery and with other negative factors, the risk of developing adhesions increases.
- Injuries to the abdomen, both open and closed. Mechanical damage is often accompanied by internal bleeding. Hematomas can occur on the intestine, lymphatic drainage suffers, metabolic processes in its tissues are disrupted. As a result, the blood flow is disturbed, the process of inflammation occurs and the adhesion is formed.
- In women, intestinal adhesions can form due to inflammation of the appendages.
- In childhood, intestinal adhesions can form as a result of congenital malformations of the organ.
- Adhesion is provoked by foreign bodies in the peritoneum and the intake of certain medications.
Additional risk factors for the formation of intestinal adhesions are:
- Mechanical intraoperative trauma;
- Intestinal tissue ischemia;
- Non-absorbable sutures;
- Postoperative infection
- Decreased local immunity;
- Blood in the abdomen
- Hyperactivity of connective tissue as an individual feature of the body;
- Inherited tendency to form adhesions.
Intestinal adhesions symptoms
Symptoms of intestinal adhesions depend on the time at which a person has intestinal obstruction. It can develop both in the early period after surgery or injury, or somewhat later - several months or even years after exposure to a provocative factor.
Symptoms of early intestinal adhesive disease
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Symptoms indicating the formation of adhesions in the first days after an injury or surgery are often veiled by the intervention itself. A person complains of periodically increasing pain in the abdomen, which to one degree or another are present on an ongoing basis. As the pathological process progresses, the pains become cramping.
- Vomiting joins, which becomes very frequent and profuse.
- If the patient has a probe inserted, the amount of fluid being separated will increase.
- Bloating is observed, but it is not uniform, as usual, but asymmetric. This is due to the fact that certain parts of the intestine are overflowing with gases.
- On palpation, the patient complains of pain. Even stroking the abdominal wall causes increased intestinal motility and discomfort.
- The chair is missing. Conducted enemas allow you to weigh only small amounts of feces.
A simple form of adhesive obstruction develops against the background of the onset of improvement after the operation. As a rule, this occurs 5-14 days after its completion. Its symptoms are distinct and do not raise questions in terms of diagnosis. Sudden sharp pains appear, vomiting of gastric contents with impurities of bile begins. The abdomen is bloated unevenly, gases and stools at the initial stage of adhesion formation can leave on their own.
It is characteristic that after a few hours the patient's condition will worsen, vomiting will intensify, signs of dehydration will join, the tongue will become dry, covered with a white bloom. The gases cease to pass, the stool disappears.
If early adhesive intestinal obstruction is formed against the background of an inflammatory process, then in addition to all the symptoms, the body temperature rises. In the intestine, an inflammatory infiltrate can be palpated, which is represented by a compacted area.
Separately, it is worth noting the early delayed adhesive intestinal disease, which manifests itself on days 21-30 after exposure to a provoking factor. Symptoms develop gradually, with a tendency to increase. Often this happens even against the background of a successfully completed operation after being discharged home.
Symptoms of late adhesive intestinal obstruction
- Symptoms develop months or years after the intervention. It is possible that the acute process will be preceded by pain in the lower abdomen.
- Suddenly, a person manifests severe pains of a cramping nature. As the process progresses, they appear more often and become stronger.
- Vomiting begins. There is no stool and gas separation.
- The abdomen acquires an asymmetric shape, this is especially noticeable in the place where there are adhesions. The bowel loop is full of gas.
- The patient's condition will worsen as dehydration and intoxication increase. Subsequently, intestinal paresis will join, if emergency care is not provided.
Diagnosis of intestinal adhesions
Diagnosis of intestinal adhesions is based on the examination of the patient and on the identification of characteristic symptoms. The doctor may suspect the formation of strands when taking an anamnesis. The indicator is the transferred surgical interventions on the intestines, the presence of infectious pathology.
To clarify the diagnosis, the following research methods are used:
- Plain radiography of the abdominal cavity. Thanks to this method, it is possible to visualize the presence of inflammatory exudate, the presence of a large amount of gas in the intestine, and its bloating. Radiography is often performed with the introduction of a specialized dye. This gives additional information about its passability. This procedure is called irrigography, in this case barium acts as a contrast agent.
- Electrogastroenterography allows you to measure electrical impulses that emanate from the intestine during its peristalsis.
- Ultrasound and MRI can accurately determine the place where the adhesions are located, as well as determine their number.
- The most informative method for detecting adhesions is laparoscopic examination. However, it is a small operation that requires incisions in the abdomen and the introduction of an instrumentation equipped with a camera into its cavity. The undoubted advantage of this procedure is that if the doctor sees a problem, he can immediately eliminate it. That is, intestinal adhesions can be removed during diagnosis.
As for laboratory tests, you will need to donate blood to rule out the presence of inflammation. It is important to carry out differential diagnosis with other types of acute intestinal obstruction, which can be caused by intestinal strictures or large tumors.
Can colonoscopy be done for intestinal adhesions?
Colonoscopy with intestinal adhesions can be done, since their presence is not an absolute contraindication to the procedure. However, some experts recommend performing the study under intravenous anesthesia. This is due to the fact that adhesions can cause severe pain during the procedure.
If the patient requires a colonoscopy, but there is a suspicion of adhesive disease, then it is better to do an irrigoscopy first. Research using a colonoscope should be carried out only in the case of low information content of irrigoscopy.
How to treat intestinal adhesions?
Treatment of intestinal adhesions involves performing surgery. Until now, it has not been possible to remove the formed fibrous fibers by means of medication. This is especially true for old, strong and dense adhesions.
However, conservative treatment is not completely rejected. It is necessary in order to prevent the formation of new strands, stop symptoms and prevent complications of the disease.
When a patient arrives with an exacerbation of intestinal obstruction, then first, it is necessary to eliminate the pain symptom. To do this, the patient is given a cleansing enema, which allows gases and feces to escape. Heat is applied to the stomach (if there is no purulent inflammation), antispasmodics are prescribed. If the patient's condition has not returned to normal after 2-3 hours, then surgical intervention is indicated, since there is a risk of developing necrosis of the intestinal areas. When it was possible to remove the obstruction, the patient is carefully monitored.
The decision on surgical intervention should be clear and balanced, since the risk of recurrence of the disease is quite high. It is possible that conservative treatment and adherence to a diet will prevent the next exacerbation of the disease. So, you can get rid of frequent constipation with a special diet. For this, the menu includes foods rich in fiber, fermented milk drinks. If it is not possible to eliminate constipation in this way, then the patient is prescribed laxatives.
Physiotherapy is also useful, including: paraffin applications, diathermy, iontophoresis. Physical activity that has a negative effect on the spasm of the intestinal musculature will need to be excluded. To eliminate vomiting, antiemetic drugs are indicated, the introduction of intravenous solutions to prevent dehydration.
When surgery is unavoidable, the preoperative preparation should be of good quality. However, emergency operations are often required when there is simply no time for proper preparation. Patients are urgently transfused with plasma, sodium chloride, Ringer-Locke solution, which makes it possible to prevent dehydration. Prednisolone in combination with Reopolyglucinum allows you to relieve intoxication from the body.
During surgery, old scars are not excised, as this can be dangerous. Indeed, often the intestinal walls are soldered to them. The adhesions are separated, pushed apart, and then removed. The technique of their excision is determined depending on the specific situation. Intestinal resection is performed if areas of necrosis are found.
A bypass is performed when the adhesions have deformed the intestine.
It is important already during the operation to carry out preventive measures aimed at preventing the recurrence of the adhesive process. For this, the incisions are made wide, do not allow the peritoneal petals to dry out. The blood must be removed in a timely manner, and the bleeding must be stopped completely. The introduction of dry antibacterial drugs or anesthetics into the wound is unacceptable. The wound is sutured with polymer threads. It is imperative to exclude the ingress of any foreign particles into the wound.
When the operation is completed, proteolytic enzymes are injected into the peritoneum. The patient is shown taking drugs from the NSAID group, antihistamines, stimulation of intestinal motility.
As for the prognosis, it is favorable in case of single spikes. If the adhesions are multiple, then in 15-20% of cases their repeated growth occurs. To prevent the formation of adhesions, you need to eat right, exercise, and avoid both overeating and starvation. Treatment of bowel pathologies should be performed as early as possible, which requires regular examinations by a gastroenterologist. Naturally, the qualifications and professionalism of doctors performing an operation on the intestine play a leading role in terms of the appearance of adhesions on its surface.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
