Abdominal adhesions
Abdominal adhesions are bands of scar tissue (fibrous or fibrofatty), most often occurring as a complication of previous abdominal surgery.
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Pathology
Adhesions often occur with
- multiple abdominal operations or previous postoperative intra-abdominal complications
- history of intra-abdominal inflammatory disease not treated with surgery
- post-radiation therapy 4
Adhesions often form between interconnecting loops of bowel. They also frequently attach loops of bowel to the parietal peritoneum, mainly the abdominal wall and the subperitoneal organs.
Radiographic features
A non-invasive tool for use in the diagnosis of adhesions is desirable, as laparoscopic exploration may result in the formation of more adhesions. The detection of intra-abdominal adhesions is based on indirect signs or abnormal visceral slide.
CT
Abdominal adhesions are rarely visible on CT, however, CT has proven to be a valuable diagnostic modality in the detection of adhesion-related complications, such as bowel obstruction or bowel ischemia. In the absence of concomitant diseases, an abrupt transition from dilated to collapsed bowel segments may be the only hint of the presence of adhesions that can be depicted on CT scans.
Fluoroscopy
Enteroclysis studies may be useful in patients with equivocal clinical symptoms or negative findings at CT.
Indirect signs include:
- hyperperistalsis
- distortion of folds with luminal narrowing
- kinking of an entire loop
Direct signs include:
- visible crossing bands
- failure of separation of adjacent loops with external manual compression
Sometimes this procedure can be useful to identify the location and the cause of an obstruction.
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