Adhesions (A) can form within the
peritoneal cavity after abdominal
surgery, especially if there is an underlying
inflammatory condition such
as appendicitis (B) or inflammatory
bowel disease. The incidence of adhesive
intestinal obstruction following a
laparotomy is approximately 2%. Most
adhesive obstructions occur within 3
months of the laparotomy, and 80%
occur within 2 years. Adhesive obstructions
tend to be more common
in children than in adults.
The patient presents with abdominal cramps, nausea,
vomiting, abdominal distension, and increased bowel
sounds. In the early postoperative period, it may be difficult
to distinguish an adhesive obstruction from a paralytic
ileus. The presence of abdominal cramps and increased
bowel sounds favors the diagnosis of adhesive obstruction.
Most adhesive obstructions resolve with nasogastric
decompression and intravenous fluids. Surgery is indicated
if the patient does not improve significantly in 6 to 12
hours. Factors that favor early operation include severe
pain, localized guarding or tenderness, fever, tachycardia,
and leukocytosis. Give antibiotics before surgery to reduce
the risk of postoperative infection. All adhesions
should be lysed during the procedure.
The following measures can reduce the incidence of
- Gentle handling of tissues during surgery.
- Avoidance of excessive use of dry pads and sponges.
- Minimal use of foreign materials (eg, excessively long
- Avoidance of mass ligatures of the omentum or the
- Proper lavage of residual blood from the abdomen.
- Use of laparoscopic surgery.