Q: How does a person find out if they have abdominal adhesions from past surgeries and what, if any, alternative treatments are there other than surgery to have them removed? Would these adhesions cause pain and discomfort up under the rib cage and back up to the bottom of the shoulder blades and across the chest? A lot of people seem to suffer from these, including possibly me.
A: Adhesions are the most common cause of intestinal obstruction in the Western world. Their formation is often unavoidable and unfortunately; the only treatment is more surgery with a procedure known as adhesiolysis. Diagnosis can be made with the assistance of an ultrasound or MRI but a CT or X-ray will not confirm the existence of adhesions. Unfortunately, you have not provided sufficient information for me to answer your questions. You intimate that you have pain and discomfort; however, have you had a surgical procedure that would make you feel you might have adhesions? If you answer yes, where was the site of the surgery? If it wasn’t under your rib cage, at the bottom of your shoulder blade or across your chest, you likely don’t have adhesions; however, the phrenic nerve innervates the rib cage, so pain in the shoulder can emanate from under the rib cage. You need to be seen by a health care professional who can examine you and perhaps order testing to determine why you are having pain. Until then, it’s anyone’s guess.
Internal organs and tissues have slippery surfaces that allow them to move and shift easily as we twist and turn. Post-surgical adhesions are fibrous bands of scar tissue that typically occur when two injured surfaces are close to each other, a situation that causes inflammation and fibrin deposits on the damaged tissue. The fibrin joins the two adjacent structures where the tissue damage occurs, seals the injury and builds an adhesion which can occur anywhere in the body but which is commonly found in the abdomen. An adhesion can begin to form within hours following surgery. With a partial or complete blockage of the intestines, there may be severe abdominal pain, bloating, vomiting and constipation. Some adhesions do not cause any problems at all and need no treatment, while others do.
A condition known as small bowel obstruction is one common consequence of post-surgical adhesions. It may occur 20 years or more following a surgical procedure if a previously benign adhesion allowed the small intestine to twist and obstruct. Depending on the severity of the obstruction, a partial obstruction may disentangle using conservative medical intervention.
The incidence of adhesions may be lowered by the use of adhesion barriers during surgery. Two methods that have been approved by the FDA are Intercede and Seprafilm. Beyond that, laparoscopic procedures that are being performed more frequently have reduced the risk for the formation of adhesions. Lastly on the positive side, surgical humidification therapy has been found to minimize the formation of adhesions.
