Adhesions (scar tissue) is a common finding after any abdominal surgery.
Adhesions/scar tissue is not visualized or seen on imaging studies (not by x-ray and not by CT scan and not by MRI), unless there is an acute kink or blockage which causes dilation of the trapped or tethered segment of intestine proximal to the adhering scar tissue. Scar tissue will not be seen in endoscopy or colonoscopy as it is scar tissue within the abdominal cavity.
I was hospitalized 4 times over a 3 month period (this past August - October) for recurrent non-relenting vomiting and severe abdominal pain. CT scans showed retained fecal matter and some small intestine dilation in the same area with each episode. I was given IV fluids, narcotics for pain, and gastrograffin (a nuclear-powered laxative) via an NG tube. Each of 3 episodes cleared with conservative management. The 4 th episode was recalcitrant. After 6 days with an NG tube the surgeon decided it was prudent to snip away at the adhesions (called lysis of adhesions).
Adhesions cause partial small bowel obstructions by tethering to a portion of the small intestine and “kinking” the segment of intestine - like a kinked garden hose. Adhesions tether to other organs, to other portions of the small intestine, and to the abdominal wall.
The small intestine is prone to partial (or full/complete) small bowel obstructions due to the nature of the small intestine. The small intestine is constantly slithering and gliding like a snake under the moist layer of fat called the omentum. It is the constant motility if the small intestine that makes the effects of a kink due to adhesions painful and symptomatic. Nausea/vomiting; little to no fecal output, or only liquid/diarrhea output that is able to pass through the narrowing; severe pain that typically comes as waves. The large intestine, given its larger diameter and lacsidasical pariataltic waves is less prone to obstruction symptoms.
I am surprised that your son’s medical team is not considering the possible role of adhesions/scar tissue. My surgeon told me that the risk of obstruction is greatest during the first year after surgery. This was my second bout of adhesions requiring surgical decompression. Surgery is to be avoided when possible because surgery will likely cause additional adhesions to develop.
The role of MiraLax or magnesium citrate (as in the product Natural Calm) is to draw water into the intestinal tract to make the fecal matter thinner in consistency and easier to pass through possible kinks or narrowed intestinal passageways. Yoga is a good activity to stretch adhesions and to prevent symptomatic obstructions.
Even with surgery last month to snip adhesions, I am having to be careful in monitoring my food choices and making sure that I keep to a regular intake of MiraLax. Like mypinkheaven mentioned, keeping to a low fiber diet (white bread, saltines) and cooked/soft vegetables (cooked carrots, mashed sweet potatoe) is important. I keep to clear liquids only when symptoms are present. Keeping well hydrated with clear liquids is also key. I drink water flavored with a Nunn’s Electrolyte Tablet.
Adhesions/scar tissue can be elusive despite causing partial obstruction symptoms. They are not readily seen on most imaging studies.
I hope that your son’s symptoms ease with time,
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.