Intestinal obstruction due to intra-abdominal adhesions is extremely common in clinical practice. Adhesive intestinal obstruction is mostly acquired except for very few congenital adhesions in the abdominal cavity. The common causes are trauma, inflammation and foreign bodies such as abdominal surgery, peritonitis, leftover gauze, etc. According to statistics, 70-90% of adhesive bowel obstructions have a history of abdominal surgery, mainly gynecological, appendiceal and lower abdominal surgery. The site of adhesive obstruction is almost always in the small intestine. The peritoneum has a large amount of fibrin-containing fluid exudate due to inflammatory reaction after the above-mentioned trauma, inflammation or foreign body irritation. Within a few hours the exudate coagulates into fibrinous loose adhesions that bind the plasma membrane surfaces of adjacent organs together. If these fibrinous adhesions are not absorbed, blood vessels and fibroblasts grow in and eventually form firm fibrinous adhesions. Blood clotting after intra-abdominal bleeding can also form adhesions by the same process.
Intestinal adhesions do not equate to intestinal obstruction. Even if there are extensive intestinal adhesions in the abdominal cavity, there is no intestinal obstruction if the intestinal curvature does not form an acute angle and the intestinal contents pass without difficulty. Abdominal X-ray fluoroscopy and plain film: the small intestine is inflated with tension and fluid level. The diagnosis of complete mechanical small bowel obstruction can be confirmed when the colon is not inflated and the barium enema shows deflation of the colon without air.
The early adhesive intestinal obstruction after surgery is commonly seen after lower abdominal surgery such as appendectomy. Often, 4 to 5 days after surgery, after intestinal peristalsis has been restored and the bowel has vented and started to eat, there is a sudden onset of paroxysmal abdominal pain with hyperactive bowel sounds, which may be accompanied by hypothermia, but generally without strangulation. As mentioned above, such adhesions are fibrinous, and most of them can be healed by self-absorption, and symptomatic treatment can be given, and surgery is generally not required.
Most of the adherent intestinal obstruction is simple obstruction, and non-surgical treatment can be applied first. The pathological changes of intestinal adhesions exist long before the occurrence of obstruction, and the passage of intestinal contents is obstructed only under the triggering factors such as intestinal dynamics disorder or full meal. With the retention of intestinal contents, the obstruction is further aggravated by edema of the intestinal wall and dilatation of the intestinal canal. If the proximal lumen of the obstruction can be effectively decompressed, the obstruction can often be relieved, and if non-surgical treatment is ineffective, surgery should be performed. Strangulated intestinal obstruction should be operated early after a short period of preparation. The purpose of surgical treatment is to relieve the obstruction and prevent recurrence. For small-scale adhesions or cords, a sharp knife can be used to separate the adhesions or remove the cords to relieve the obstruction, and the rough surface can be sutured inward to reduce the chance of re-adhesion. If the intestinal curvilinear adhesions are difficult to separate and do not involve many intestinal segments, the adhesions can be resected and intestinal anastomosis can be performed. If the adhesions are extremely extensive, it is necessary to perform additional surgery for small bowel alignment to prevent re-adhesion and obstruction after separation of adhesions.