Adhesive Obstruction: A Postoperative Complication

Adhesions (A) can form within theperitoneal cavity after abdominalsurgery, especially if there is an underlyinginflammatory condition suchas appendicitis (B) or inflammatorybowel disease. The incidence of adhesiveintestinal obstruction following alaparotomy is approximately 2%. Mostadhesive obstructions occur within 3months of the laparotomy, and 80%occur within 2 years. Adhesive obstructionstend to be more commonin children than in adults.The patient presents with abdominal cramps, nausea,vomiting, abdominal distension, and increased bowelsounds. In the early postoperative period, it may be difficultto distinguish an adhesive obstruction from a paralyticileus. The presence of abdominal cramps and increasedbowel sounds favors the diagnosis of adhesive obstruction.Most adhesive obstructions resolve with nasogastricdecompression and intravenous fluids. Surgery is indicatedif the patient does not improve significantly in 6 to 12hours. Factors that favor early operation include severepain, localized guarding or tenderness, fever, tachycardia,and leukocytosis. Give antibiotics before surgery to reducethe risk of postoperative infection. All adhesionsshould be lysed during the procedure.The following measures can reduce the incidence ofpostoperative adhesions:

• Gentle handling of tissues during surgery.
• Avoidance of excessive use of dry pads and sponges.
• Minimal use of foreign materials (eg, excessively longsutures).
• Avoidance of mass ligatures of the omentum or themesentery.
• Proper lavage of residual blood from the abdomen.
• Use of laparoscopic surgery.