Adhesiolysis (adhesions and adhesive bowel obstruction)

After abdominal surgery or an abdominal infection, adhesions may form: these are internal scars that stick loops of bowel to each other or to the abdominal wall. Sometimes a band (a fibrous cord) traps or kinks the bowel and blocks transit: this is adhesive small bowel obstruction, with pain, vomiting, a swollen abdomen and an inability to pass wind or stools. Adhesiolysis consists of cutting these bands and releasing the adhesions to free the bowel. It is performed laparoscopically when possible, otherwise through an incision. The surgeon then checks that the bowel is healthy; if it has been irreversibly damaged, the damaged segment is removed and the bowel rejoined. Many adhesive obstructions resolve without surgery, by resting the bowel (fasting, intravenous fluids, a stomach tube) and giving a contrast agent that helps transit to resume. Surgery is offered when the obstruction does not resolve, when there are signs that the bowel is suffering, or in case of repeated obstructions. At Clinique Pasteur Tunis, bowel obstructions are managed in the emergency department, which is open around the clock, with on-site CT scanning and an operating theatre available day and night when surgery is decided.