Indexing Title:

RJOSON’s Medical Anecdotal Report [05-5]

MAR Title:

Unpredictability of Intraabdominal Adhesions in Patients with Multiple Celiotomies

Date of Medical Observation: June, 2005

Narration:

A 45-year-old female was admitted because of signs and symptoms of intestinal obstruction.  The primary consideration was postoperative adhesions as she had history of previous operations.  She had a total of about 6 operations since she was aged 28 years old.   These operations consisted of right transverse colostomy; left hemicolectomy for descending carcinoma; closure of colostomy; appendectomy; and 2 cesarian sections.    Seventeen years after her cancer operations, she had no signs of recurrence.  What she had was an intestinal obstruction caused by postoperative adhesions as seen in her latest celiotomy. 

When I initially diagnosed her to have partial intestinal obstructions secondary to postoperative adhesions, I was praying and hoping that she would be relieved with conservative management so that I didn’t have to operate on her.  I was anxious of the dense and massive adhesions that I might encounter because of the 6 previous operations. When her obstruction became persistent and progressive, I had no choice but to operate.   On operation, I was surprised and pleased to find minimal to moderate and easy to remove adhesions.

Insights (Discovery, Stimulus, REINFORCEMENT) / (PHYSICAL, Psychosocial, Ethical):

I had encountered and operated on quite a number of patients with postoperative adhesions.   At the start of the celiotomy, I could NOT predict what would be the situation inside, whether the adhesions would be dense or not; whether they would be massive or minimal or moderate.   After operating on several patients in the past with dense and massive adhesions, averaging about 10 hours and with me ending exhausted, I always hope that I will not meet such situations again.  With the aforementioned patient with 6 previous abdominal operations, I was expecting the worst scenario.  However, the adhesions turned out not to be that bad afterall.  Degree of postoperative adhesions really are unpredictable prior to a celiotomy!  The number of operations is not an assurance for dense and massive adhesions.