Gallbladder adhesions are bands of scar tissue that form between the gallbladder and other organs within the abdominal cavity. These fibrous connections cause organs that are normally separate to stick together. Adhesions form as part of the body’s healing process following tissue damage or inflammation. While they can form anywhere in the abdomen, gallbladder adhesions are most commonly associated with a preceding cholecystectomy, which is the surgical removal of the gallbladder. Adhesions are a frequent complication of any abdominal surgery, affecting up to 93% of people who undergo such procedures.
The Mechanism of Adhesion Formation
Adhesion formation begins with an inflammatory response following injury to the peritoneal tissue, the lining of the abdominal cavity. This injury often results from surgery, such as a cholecystectomy, or severe inflammation. The trauma triggers the body’s repair mechanism, activating the coagulation cascade and rapidly producing a fibrin matrix, a temporary scaffold.
Normally, this temporary fibrin is dissolved by fibrinolysis. If the balance between fibrin formation and dissolution is disrupted, the fibrin persists and becomes organized. Fibroblasts migrate into the scaffold and lay down collagen, transforming the temporary fibrin into permanent scar tissue that connects adjacent organs. Surgery is the primary trigger, but factors like thermal injury, infection, or foreign materials can exacerbate the risk.
Recognizing the Signs of Gallbladder Adhesions
Gallbladder adhesions often do not produce symptoms. When symptoms occur, they are vague and difficult to distinguish from other digestive issues. The most common presentation is chronic or intermittent abdominal pain, localized in the upper right quadrant where the gallbladder once was. This discomfort is caused by the adhesion pulling on nerves or restricting organ movement.
Patients may describe a sensation of tugging, stretching, or cramp-like pain that sometimes worsens after eating. Adhesions can also interfere with normal digestive function, leading to symptoms like bloating, nausea, and changes in bowel habits. In severe cases, the fibrous bands can cause a small bowel obstruction. Warning signs of an obstruction include severe, worsening abdominal pain, inability to pass gas, vomiting, and abdominal distension, requiring immediate medical attention.
Confirming the Diagnosis
Diagnosing gallbladder adhesions presents a challenge because standard imaging techniques cannot visualize the scar tissue directly. Physicians rely on a detailed patient history, documenting prior abdominal surgeries, and a thorough physical examination. Imaging studies like ultrasound or CT scans are used primarily to exclude other potential causes of symptoms, such as a retained gallstone or a bile duct issue.
Specialized imaging, such as MRI of the small bowel, may suggest adhesions by showing kinking or abnormal dilation of the intestine. However, a definitive diagnosis requires a surgical procedure, most often a diagnostic laparoscopy. During this minimally invasive procedure, a surgeon uses a small camera to directly visualize the abdominal cavity and confirm the presence of the fibrous bands.
Treatment and Management Strategies
The approach to treating gallbladder adhesions depends on the severity of the patient’s symptoms. For mild discomfort, the initial management is conservative, involving pain control using medication and making dietary adjustments. Many patients find their symptoms can be managed without an invasive procedure.
Surgical intervention is reserved for severe cases, particularly when adhesions cause debilitating pain or bowel obstruction. The procedure to remove or divide the adhesions is called adhesiolysis, typically performed laparoscopically. While surgery provides immediate relief, the act of operating can trigger the body’s healing response and cause new adhesions to form, known as recurrence. Therefore, the decision to proceed involves careful consideration of the potential benefits versus the risk of recurrence.