Enterolysis (Lysis of Adhesions-scar tissue)

The Condition

There may be a blockage in the small bowel that is caused by scar tissue. The source of this scar tissue usually is from previous surgery.  Enterolysis will cut this scar tissue away, thus unblocking the bowels.

Symptoms

• Nausea and vomiting
• Crampy abdominal pain
• Inability to pass gas and/or defecate

Enterolysis

The operation can be done both open or laparoscopically.  For the open surgery, the surgeon will make a large incision whereas for the laparoscopic he will make about 3-4 small punctures in the abdominal wall.  A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of the abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to cut the scar tissue in order to relieve the intestinal obstruction. This type of operation can be extremely difficult and time-consuming to perform, especially if there is a large amount of scar tissue. In some cases, a diseased portion of the small bowel may need to be removed. This would be done with surgical staplers, and the bowel would be re-connected so that the patient could eat. If a segment of bowel does need to be removed, then it is extracted from the abdomen through one of the small incisions for the laparoscopic surgery.  After all this has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.   For the open surgery the wound is closed with sutures or staples.

Nonsurgical Treatment

Sometimes a bowel obstruction can be treated by suctioning out the contents of the stomach, giving IV fluids, and not letting the patient eat for a few days. If there is a mass or tumor in the small bowel that is causing the obstruction, then this is best treated with surgery.

Risks

The primary risks of enterolysis (adhesiolysis) are:
Infection of the skin at the incision sites.  This complication is more prone to happen with open surgery. 

• Iatrogenic (doctor induced) perforation of the intestine
• Collection of pus inside the abdomen (intra-abdominal abscess)
• Postoperative ileus (the intestines slow down/stop working for several days)
• Recurrent small bowel obstruction
• Incisional hernia (more prone to happen after open surgery)

Medical Negligence

The above mentioned risks and complications are known to happen with adhesiolysis (enterolysis) and such complications do not necessarily constitute deviation from the medical standard of care.  The following examples however may be considered as medical negligence.

• Perforation of the intestine or colon by the blind insertion of a trocar or a verres needle with prior knowledge of probable extensive intra-abdominal adhesions.
• Perforation of intestine (by instruments or electrocautery) during adhesiolysis and delayed diagnosis due to lack of attention to symptoms, signs and results of diagnostic testing.