Adhesion syndrome of omentum

　　Mesenteric adhesion syndrome often occurs after abdominal inflammation or surgery, especially after appendectomy and tubal ligation. The omentum and peritoneum near the lower abdominal incision become adherent to the organs, with a higher incidence rate for the former. After adhesion formation, the omental fibers fibrotize and shorten, pulling the transverse colon and peritoneum or organs at the adhesion site. Additionally, during overeating, changes in body position, intense physical activity, or gastrointestinal dysfunction, especially bloating, the omentum is pushed forward, increasing the traction on the transverse colon and peritoneum. Sometimes, the small intestine can form an internal hernia between the omentum and the anterior abdominal wall, which can also cause symptoms.

　　The most characteristic manifestation of mesenteric adhesion syndrome is peritoneal traction symptoms. Patients dare not straighten their trunk, often walk with a bent waist, especially after a heavy meal. Symptoms such as loss of appetite, nausea, vomiting after meals, and bloating, among other gastrointestinal dysfunction symptoms, may occur. Additionally, some patients may exhibit symptoms of incomplete obstruction of the transverse colon, such as constipation and episodic abdominal pain. Changing body position, curling side-lying, often relieves abdominal pain. During physical examination, tenderness can be felt at the site of adhesion, which is usually located in the lower right abdomen.

　　Most patients with mesenteric adhesion syndrome have a history of lower abdominal surgery in the recent past, especially appendectomy and uterine adnexal surgery. The onset of the disease usually begins 2 weeks after surgery, but some patients may develop symptoms several years after surgery. A considerable number of patients have some triggering factors before onset, such as overeating and frequent physical activity.

　　I. Symptoms

　　Abdominal pain is a common complaint, with pain usually occurring about half an hour after a meal, mainly in the upper middle abdomen, presenting as episodic bloating pain, lasting from several minutes to more than ten minutes each time. Some patients may experience severe persistent colic, with episodic exacerbation, indicating severe illness. In mild cases, the abdominal symptoms can be significantly relieved or even disappear when assuming a flexed side-lying position. Accompanying symptoms of abdominal pain include nausea, vomiting, bloating, and poor appetite. Most patients experience constipation, with a bowel movement 1 time every 3 to 5 days. Some patients may seek medical attention due to refractory constipation, all of which are manifestations of transverse colon emptying obstruction.

　　II. Signs

　　There is mild tenderness in the abdominal incision scar area and the upper middle abdomen, sometimes with palpable overly distended transverse colon. Abdominal muscle tension and rebound pain are not obvious, and some patients may exhibit a positive sign of abdominal wall traction. The examination method is as follows:

　　1. The Trunk Overextension Test: The patient is asked to lie on the examination bed on their side, trying to extend their trunk backward as much as possible (i.e., push the chest and lower limbs backward to lift the waist forward), or complete this posture with the help of a doctor. Pain in the surgical incision area or the upper middle abdomen is considered positive.

　　2. Incision pull-down test: The patient lies on his back, and the examiner presses the upper part of the incision with his hand and pulls it down with force. Abdominal pain is positive.

　　The purpose of the above examination methods is to pull the adherent and contracted omentum with force, increase the degree of downward movement of the transverse colon, and produce symptoms.

　　To prevent the occurrence of omental adhesion syndrome, attention should be paid to the following issues during and after surgery:

　　1. Avoid using the omentum to fix the residual end of the appendix during appendectomy to avoid increasing the chance of adhesion.

　　2. If there is insufficient blood supply to the omentum during surgery, it should be resected to avoid adhesion with the lower abdominal wall in the future due to inflammation.

　　3. Flatten the omentum and restore it to its original position before closing the abdomen, suture the abdominal incision, and do not suture the omentum to the incision by mistake.

　　4. Promote gastrointestinal motility after surgery to reduce the occurrence of adhesion.

　　Omental adhesion syndrome should be examined with X-ray. Abdominal X-ray or plain film shows dilated ascending colon loops and dilated aerated small intestine, sometimes with a liquid level. Barium enema can detect widened or fixed ascending colon, and the barium through the transverse colon is obstructed.

　　Patients with omental adhesion syndrome should maintain regular and reasonable diet, mainly high-protein and high-vitamin foods. Choose high-nutritious plant or animal proteins such as milk, eggs, fish, lean meat, and various bean products.

　　The treatment method for omental adhesion syndrome is determined according to the duration of the disease course and the severity of the symptoms.

　　Firstly, non-surgical treatment

　　Non-surgical treatment is suitable for mild symptoms and occasional onset. Adjusting diet, abdominal therapy, adequate rest, and using antispasmodic and laxative drugs can alleviate symptoms.

　　Secondly, surgical treatment

　　For those without surgical treatment options, surgical treatment can be considered.

　　1. Laparoscopic surgery: Cut the fibrotic adherent omentum to relieve the traction on the transverse colon, so that the symptoms can be alleviated. This method has less surgical trauma and faster recovery.

　　2. Laparotomy: Cut the adherent omentum or resect the fibrotic contracture of the omentum to relieve the obstruction of the transverse colon.