Surgical Management of Bands and Adhesions

Abstract

The intestine is fixed at two peritoneal reflections: the ligament of Treitz proximally and the ileocecal fold, or ligament of Treves distally. Normal embryologic rotation is required for the fixation of these points and orientation of the intestine. Embryologic rotation may be arrested resulting in malrotation most commonly diagnosed within the first year of life which is discussed in detail in another chapter. Rarely, malrotation is diagnosed in adult patients and adhesions between the cecum and duodenum (Ladd bands), or a narrow mesentery base are identified. By far the most common cause of intestinal obstruction in Western world is adhesions caused by previous surgery and scarring. Approximately 95% of patients who undergo abdominal surgery will develop adhesive disease which is a result of normal healing.