Republic of the Philippines ISABELA STATE UNIVERSITY Echague, Isabela COLLEGE OF NURSING

A Case Abstract on

ABDOMINAL ADHESIONS

Submitted by: David D. Dueas BSN IV Group 1

Submitted to: Mrs. M. N. Abuan, RN, MAN Clinical Instructor

ABDOMINAL ADHESIONS Abdominal adhesions are bands of scar tissue that have formed inside the abdomen. They can form between the inside lining of the abdominal wall and the intestine (the peritoneum, including the omentum), between loops of small intestine, or between any of the abdominal organs. Abdominal adhesions may form in response to surgery, bleeding, or an inflammatory disease in the abdomen as part of the body's normal attempt to repair itself. After surgery, adhesions begin to form within the first few days and may progressively enlarge, eventually producing symptoms after months or years (Hardin). Adhesions are the most common cause of bowel obstruction, particularly in the small bowel, because the adhesion wraps around the intestine, progressively blocking a portion of the bowel. Adhesions can also result in blockage of blood flow to parts of the bowel, called strangulation, which requires immediate surgical treatment. In women, adhesions may form on or adhere to the ovaries, uterus, and fallopian tubes (pelvic adhesions), resulting in obstruction of the reproductive tract and often leading to infertility.

Risk Factors Although abdominal adhesions most commonly occur following abdominal or pelvic surgery, they can also occur in those who have never had surgery. Adhesions can result from endometriosis, perforated ulcers, appendicitis, or infections in the fallopian tubes. Other causes of adhesions include radiation treatment of the abdomen, or a foreign substance or object left in the abdomen after surgery. Any trauma to the abdomen may result in adhesions. Adhesion formation remains a major complication after lower abdominal and gynecologic operations. Although more of these procedures are now being done through use of a small incision and a scope (laparoscopy), the rate of adhesion formation has not significantly decreased.

Diagnosis History: Individuals usually report prior abdominal surgery, particularly if a postoperative infection developed. Although the majority of abdominal adhesions are asymptomatic, cramping, bloating, and intense abdominal pain are the primary symptoms of adhesions that are causing partial intestinal obstruction. Nausea followed by vomiting that may occur in waves is also reported if the adhesion causes complete intestinal obstruction. With symptomatic pelvic adhesions, females may report experiencing painful intercourse or being infertile. Tests: Plain abdominal x-rays or contrast films (upper GI or barium enema) may reveal small bowel obstruction. If pain is the only symptom and there is no evidence of intestinal obstruction,

many other tests may be done to confirm the diagnosis. Visually examining the various areas and levels of the gastrointestinal tract with various scopes (endoscope, colonoscope, sigmoidoscope, proctoscope) can identify strictures probably due to adhesions. MRI evaluation may be useful in some cases. In cases in which the diagnosis is questionable, surgical exploration and visualization, either by laparoscopy or laparotomy, may be the definitive diagnostic test.

Treatment Surgical release of adhesions is the only effective treatment, but it may be problematic since surgery may have been the original cause of adhesions. Adhesiolysis of both abdominal and pelvic adhesions can often be performed through a scope inserted through a small skin incision (laparoscopy). Through the laparoscope or via open surgical procedure, the adhesions will be cut (sharp dissection), electrically coagulated, or treated with laser (ablation). If an area of bowel has had its blood supply cut off, it may be necessary to remove (resect) that portion of intestine. This may necessitate connecting the bowel to the abdominal wall (ostomy); it may be possible to reconnect the bowel at a later time.

Nursing Management 1. After surgery, the nurse places the patient in a high Fowlers position to reduce tension on the incision and abdominal organs, helping to reduce pain, 2. An opioid is prescribed to relieve pain. 3. Oral fluids are administered when tolerated. 4. When the patient is ready for discharge, the patient and the family are thought to care for the incision and perform dressing changes and irrigation as prescribed.

Complications Abdominal adhesions are permanent unless a surgical procedure to remove symptomatic adhesions is performed. More adhesions may develop following the surgery to remove the original adhesions. Bleeding, infection, and mechanical injury may occur as complications after surgery