Intestinal adhesions - Adhesion of the Intestine

Japanese: 腸管癒着症 - ちょうかんゆちゃくしょう（英語表記）Adhesion of the Intestine

[What kind of disease is it?]
Adhesion occurs between the intestines, or between the intestines and the peritoneum or omentum, causing obstruction to the passage of fluid, which results in symptoms such as abdominal pain.
Intestinal adhesions occur when the serous membrane that covers the outermost part of the intestine is damaged by trauma or inflammation, and during the healing process. It is normal for some adhesions to be seen after abdominal surgery.
●After what types of surgeries is it likely to occur? It can occur after any type of abdominal surgery, but it is most commonly seen after benign surgeries such as surgery for appendicitis, gastric or duodenal ulcers, and gynecological surgery, rather than surgery for malignant tumors.
Although most of these are nothing to worry about, various disorders can occur if the intestines are pulled or bent by adhesions. In addition, psychological factors are also involved in intestinal adhesions, and the degree of adhesions and symptoms do not necessarily match, with some people complaining of severe symptoms even though they have almost no adhesions.
[Symptoms]
The main symptom is abdominal pain, along with other vague symptoms such as nausea, loss of appetite, abdominal distension, and abdominal discomfort. In addition, neurological symptoms such as insomnia, anxiety, and general fatigue may also appear.
The patient will be seen at a gastroenterological surgery department, but the examination may also be conducted together with a psychosomatic medicine department.
[Testing and diagnosis]
Intestinal adhesions are diagnosed directly by observing the abdominal cavity using a laparoscope. However, in some cases, it can be diagnosed by taking an X-ray examination after swallowing a contrast agent or injecting it into the anus, and finding bowels or abnormal courses of the intestine.
In many cases, adhesions are suspected when there is vague abdominal symptoms, mainly abdominal pain, but no disease of the digestive tract, liver, gallbladder, pancreas, urinary tract, or gynecological disease, and a history of abdominal surgery or peritonitis.
[Treatment]
Even if there is intestinal adhesion, we do not immediately perform another surgery. We first try to improve the obstruction by having the patient eat easily digestible foods with little residue, or fasting and receiving sufficient intravenous drips. If surgery to remove adhesions is performed carelessly, there is a risk that adhesions will develop again, and the patient will have to undergo surgery multiple times. However, if there is also intestinal obstruction, the situation is different.
If symptoms are mild, intestinal motility regulators or tranquilizers are taken.

Source: Shogakukan Home Medical Library Information

Japanese:

[どんな病気か]
　腸管と腸管、あるいは腸管と腹膜（ふくまく）や大網（たいもう）が癒着したために通過障害がおこり、それによって腹痛などの自覚症状がみられるものです。
　腸管の癒着は、腸管のいちばん外側をおおっている漿膜（しょうまく）が外傷や炎症などで傷つけられ、その傷が治癒（ちゆ）する過程でおこります。開腹手術後は、多少とも癒着がみられるのがふつうです。
●どんな手術の後におこりやすいか
　あらゆる腹部手術の後におこるといえますが、なかでも多いのは虫垂炎（ちゅうすいえん）や胃・十二指腸潰瘍（じゅうにしちょうかいよう）の手術、婦人科手術など、悪性腫瘍（あくせいしゅよう）の手術よりも良性の手術の後に多くみられます。
　心配のないものが多いのですが、癒着で腸管が引っ張られたり、屈曲したりすると種々の障害がおこります。また、腸管癒着症には精神的な要素も関与していて、癒着の程度と症状とは必ずしも一致せず、ほとんど癒着がないのに強い症状を訴える人もいます。
[症状]
　おもな症状は腹痛で、ほかに悪心（おしん）、食欲不振、腹部膨満感、腹部不快感などの不定愁訴（ふていしゅうそ）がみられます。さらに、不眠、不安感、全身の倦怠感（けんたいかん）などの神経的症状がみられることもあります。
　受診先は消化器外科ですが、診察は心療内科といっしょに行なうこともあります。
[検査と診断]
　腹腔鏡（ふくくうきょう）を使って腹腔内を観察して腸管癒着を直接診断します。ただし、造影剤を飲んだり肛門（こうもん）から注入してＸ線検査を行ない、腸管の屈曲（くっきょく）や異常走行がみられれば診断できる場合もあります。
　多くの場合、腹痛を主とする腹部の不定愁訴があるにもかかわらず、消化管、肝臓、胆嚢（たんのう）、膵臓（すいぞう）、尿路の疾患や婦人科疾患がなく、腹部手術や腹膜炎の既往（きおう）があるときに癒着が疑われます。
[治療]
　腸管癒着があってもすぐに再手術を行なうわけではありません。残渣（ざんさ）の少ない消化のよいものを摂取するか、絶食して十分な点滴を行ない、まず通過障害の改善をはかります。安易に癒着の剥離（はくり）手術を行なうと、再び癒着をひきおこし、何度も手術しなくてはならなくなる危険があるのです。しかし、腸閉塞を合併したときは別です。
　症状が軽い場合は、腸管運動調節薬やトランキライザーを服用します。

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