Adhesions are bands of internal scar tissue that develop inside the abdomen — most commonly after surgery, but sometimes after inflammation (such as appendicitis or diverticulitis), endometriosis, or for no obvious reason at all. They form between loops of bowel, or between bowel and the inside of the abdominal wall.
Most adhesions cause no problems and you never know they are there. Occasionally, though, a band of scar tissue catches a loop of bowel and kinks or twists it — and that causes a small bowel obstruction, where the bowel cannot pass its contents downstream. This can happen years or even decades after the original surgery.
If you have had a previous episode, you may be worried about another one. The reassuring news is: most episodes settle with simple, conservative measures — not surgery — and there is plenty that can be done.
Previous abdominal or pelvic surgery is by far the most common cause. Open surgery causes more adhesions than laparoscopic (keyhole) surgery, but no operation is completely adhesion-free.
Other causes include inflammation inside the abdomen (peritonitis, appendicitis, severe diverticulitis), endometriosis, previous intra-abdominal infection, and radiotherapy to the pelvis. Some people seem to form more adhesions than others, for reasons we do not fully understand.
An adhesional obstruction usually causes a fairly recognisable set of symptoms: cramping abdominal pain that comes and goes in waves, nausea and vomiting (sometimes vomiting brown fluid that looks and smells like stool — a sign of significant obstruction), a swollen, bloated belly, and being unable to pass wind or open your bowels.
Some episodes are more subtle — a partial obstruction can come and go, with intermittent cramping or feeling unwell after meals over days or weeks. Either way, prompt medical assessment is important so the right tests can be done.
Diagnosis is made on a careful clinical assessment and a CT scan of the abdomen. The CT shows the level of obstruction — the point where dilated bowel above meets collapsed bowel below — and importantly, looks for any signs that the bowel itself might be in trouble (called ischaemia), which would change the urgency of the treatment plan.
Blood tests check hydration and electrolyte balance, and pick up early signs that the bowel may be in trouble.
Most episodes of adhesional obstruction settle without surgery — around 70–80% within 24–72 hours. The treatment is straightforward: admission to hospital, nothing by mouth (so the bowel can rest), intravenous fluids, sometimes a nasogastric tube (a soft tube through the nose to the stomach, to decompress things and stop the vomiting), and close observation.
A drink of contrast (called gastrografin) is sometimes given — it shows on CT or X-ray and can also have a mild laxative effect that helps the obstruction settle. It is both a test and a treatment in one.
Surgery is needed if: conservative management has not worked after 3–5 days; there are signs the bowel itself is suffering (severe constant pain, rigid abdomen, abnormal blood test results suggesting the bowel is in trouble); or the CT shows a closed-loop obstruction (a particularly dangerous pattern). These are not common scenarios, but when they happen, surgery is the right answer.
The operation involves carefully dividing the adhesions causing the obstruction (called adhesiolysis) — done laparoscopically (keyhole) wherever possible to reduce the chance of new adhesions forming, and via an open approach when keyhole is not suitable. If a segment of bowel has been damaged, it is removed.
If you have had one episode of adhesional obstruction — whether you needed surgery or not — you are at higher risk of another. This is a frustrating but real fact. Surgery itself does not eliminate the risk because it can paradoxically create new adhesions.
For recurrent episodes, the decision to operate is balanced carefully — each surgery has a chance of buying long-term improvement but also a chance of contributing to the underlying problem. What is right for your situation will be discussed individually at consultation.
Most episodes of adhesional obstruction are managed without surgery. When surgery is needed, Mr Nguyen uses a laparoscopic approach where the situation allows — it carries a lower risk of forming new adhesions than open surgery, and recovery is much faster.
For people who have had multiple episodes, the conversation about further surgery is taken seriously and unhurried — including the honest acknowledgement that no operation can guarantee no further trouble.
Seek urgent medical assessment — usually through the emergency department — if you have severe cramping abdominal pain, persistent vomiting, a swollen and bloated belly, and inability to pass wind or open your bowels. These symptoms together suggest an obstruction that needs immediate attention.
For recurrent or intermittent symptoms, see your GP for a referral for specialist review and planning.
Some adhesions form after most open abdominal operations — that is the body's normal response to surgery. But most of these adhesions never cause symptoms. Only a minority of people develop adhesions that actually cause bowel obstruction. Laparoscopic surgery causes far fewer adhesions than open surgery.
Not entirely — but they can be reduced. Using a laparoscopic approach, gentle handling of the bowel during surgery, and (in selected cases) special anti-adhesion barriers placed at the end of the operation, all help. There is no perfect prevention yet.
Not necessarily. Most patients settle conservatively and never need an operation for it. A small proportion who have multiple severe or prolonged episodes eventually consider surgery, but this is a careful decision balanced against the risk of new adhesions.
There is no proven dietary or lifestyle change that prevents recurrence — but some people find that avoiding very large meals or foods with tough, indigestible parts (raw kale, dried fruit, mushrooms, citrus pith) reduces episodes of partial obstruction. Staying well hydrated and not letting yourself become very constipated is sensible. If something seems to trigger episodes for you, it is reasonable to avoid it.
Have questions about adhesions & recurrent small bowel obstruction?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.