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Bowel adhesions are the joining together of the bowel, often with scar tissue from surgery or illnesses like endometriosis or Crohn’s disease, which may create serious bowel functioning issues or risk to bowel integrity. Though most people only develop minor adhesions after any type of bowel surgery that poses no risk, sometimes the joining is significant and causes partial to total bowel blockage. When this occurs, additional surgery or treatment could be necessary to remove the adhesions or repair blockages.
The small and large bowels are complex structures that loop over each other in a variety of ways. When surgery is performed or if scarring occurs from within these structures, there is potential for bowel adhesions to form. Parts of the bowel can become connected to each other through scar tissue, or in conditions like endometriosis, endometrial tissue connects to bowel parts, particularly common in the upper bowel. Due to the way the bowels are structured, it’s not that difficult for scarring to result in joining that partially obstructs the movement of food and liquids.
When bowel adhesions are significant, they may cause total obstruction, resulting in severe abdominal and sometimes pelvic pain, inability to have bowel movements, nausea or vomiting, fever, and potentially bowel perforation. This last is a great risk because the contents of the bowel can spill into the abdominal cavity and cause systemic infection. Suspected bowel rupture or perforation is medically urgent, and the other symptoms described above need immediate treatment, too.
Given the risks of bowel perforation, claims of having bowel adhesions or obstruction are usually taken quite seriously by physicians. To investigate this matter a number of scans might be performed including computerized tomography (CT) scans or magnetic resonance imagine (MRI). More extensive testing could include colonoscopy or barium x-rays to look for specific areas of bowel adhesions or blockages.
People who have bowel surgery of any kind are usually cautioned to be on the lookout for evidence of bowel adhesions, though in early stages there may be few symptoms of their presence. They may only become problematic if they begin to block bowel functioning at a later point, and adhesions could take some time to develop after surgery. Those with chronic bowel conditions or with endometriosis might also be cautioned that scarring in the bowels could result in bowel adhesions.
When adhesions prove problematic and threaten to or are already obstructing the bowel, the standard of care is to remove them surgically. Those with significant scarring from Crohn’s disease may simply developing more scarring from surgeries and end up needing bowel resections repeatedly to control this condition. Some doctors feel that non-surgical approaches to Crohn’s are better for as long as possible to avoid this slippery slope.
Each case is highly individualized. For some, surgical treatment to remove adhesions is the appropriate course. Surgery is definitely necessary for total bowel blockage or perforation, as without it, these conditions can be fatal.