You should seek the advice of your veterinarian if your pet is ill as only he or she can correctly advise on the diagnosis and recommend the treatment that is most appropriate for your pet.

Adhesions form within the peritoneal cavity during the  inflammatory stage of healing - and they can cause problems later - so prevention and proper management are important

Adhesions consist of bands of fibrin (early stage) or fibrous tissue (later stage) and they take several forms :

• Reversible - fibrinous adhesions which can disappear within 5-6 days after they form
• Irreversible - when the bands consist of capillaries and fibroblasts - usually occurs once an adhesion has been present for 5 days or more
• Restrictive  - firm adhesions which tightly bind adjacent tissues - this form of adhesion is most likely to lead to strangulation or obstruction of viscera in the abdominal cavity
• Non-restrictive - loose adhesions, such as those involving the omentum. These rarely lead to strangulation or obstruction of viscera.  

Adhesions form within 24-48 hours as part of an inflammatory process, and although they usually link to serosal surfaces, a defect in, or damage to the peritoneal surface is not always required for an adhesion to form. There are several possible causes of adhesion formation :

• Damage to serosal surfaces - eg wounds, rough handling, dehydration (during surgical exposure)
• Anoxia within the tissues - eg due to impaired blood supply, excessive electrocautery
• A foreign body in the tissue - eg suture materials, gauze swab material, sterile powder used to dust surgical gloves
• Infections
• Antibiotic or other medications used within the peritoneal cavity
• Organising blood clots

Adhesions can be advantageous to the patient in certain circumstances - such as when an adhesion seals a defect in a ruptured viscus, or stops bleeding when an organ (eg the spleen) ruptures, or by walling off infection in cases with peritonitis. Indeed surgically creating adhesions between adjacent viscera is an excellent technique to prevent leakage into the abdominal cavity from defects. This is most often achieved by stitching the serosal surface of one loop of intestine over a defect in another loop of intestine. This technique for repair of intestine wall defects is helpful because it reduces the degree of narrowing of the lumen in the loop of intestine with the defect compared to conventional closure techniques.

There are several factors which are known to increase the likelihood of fibrinous adhesions being resorbed before they become irreversible :

• A good blood supply to the mesothelium :
  • Good oxygen supply
  • Good supply of nutrients
  • Efficient removal of waste products
• Intact mesothelial and sub-mesothelial cells which secrete fibrinolytic substances
• Removal of the local cause of the inflammatory reaction 

The following precautions should help to prevent the development of adhesions following surgical procedures :

• Good surgical technique to preserve blood supply to tissues
• Gentle handling of abdominal organs
• Frequent dousing of exposed abdominal organs with sterile saline
• Use omentalisation to cover wounds in the serosal surface of viscera
• Adhere to good aseptic surgical technique
• Avoid using materials that might fray and leave foreign material in a surgical site
• Avoid getting sterile dust on the outside of surgical gloves
• Choose appropriate types and amounts of surgical suture material for the tissue
• Flush the peritoneal cavity thoroughly to remove foreign debris and blood clots before closing a laparotomy wound 
• In certain circumstances the use of anti-inflammatory drugs may be beneficial - but these may also delay primary healing of the main wounds, and reduce the immune response to infections.

Treatment may involve the surgical sectioning of individual restrictive adhesions to free a trapped viscus . If a patient has multiple adhesions surgery may not be feasible and the adhesions may reform.

Updated January 2016