Sigmoid Adhesions May Explain IBS-like Symptoms

OB/GYN News, June 15, 2001 by Kathryn Demott

CHICAGO -- Adhesions surrounding the sigmoid colon may be the root of irritable bowel syndrome--like symptoms in some patients with pelvic pain, Dr. Brent W. Bost said at the annual meeting of the American College of Obstetricians and Gynecologists.

The adhesions are filamentous or fibrous attachments that bind the sigmoid colon to the pelvic sidewall tight enough to alter the course of the colon, sometimes causing a slight narrowing or kink that creates a bottleneck effect, explained Dr. Bost of St. Elizabeth Hospital, Beaumont, Tex.

In a poster presentation, Dr. Bost described an observational study in which 146 women underwent laparoscopy for pelvic pain. A total of 56 women were found to have sigmoid adhesions, and among them 34 women had no other reasonable source of their symptoms besides the sigmoid adhesions. Endometriosis and pelvic infection were ruled out.

All 34 women with sigmoid adhesions only had their adhesions lysed using a [CO.sub.2] laser or cautery. The bowel was returned to a normal position. The degree of pain and gastrointestinal symptoms correlated well with the extent of adhesions found during surgery. All of the women had experienced symptoms for at least 6 months; more than 40% had experienced symptoms for longer than 1 year.

Six months after the adhesions were cut, 91% of the women reported a significant reduction in gastrointestinal symptoms and/or pelvic pain. After 18 months, 80% of the women still reported pain relief and symptom relief.

Traditionally, surgeons have considered these adhesions surrounding the sigmoid colon to be normal or of no clinical significance, Dr. Bost said. But the findings of this study suggest that they may actually be a significant source of pelvic pain, bloating, and cramping.

Currently providers don't even look for these adhesions, let alone treat them, he added.

It's unlikely that these deflecting sigmoid adhesions have an etiology similar to that of endometriosis, given that endometriosis was ruled out in 60% of the women with colon adhesions. In addition, it's doubtful that sigmoid colon adhesions are related to menstruation, since they also have been seen in men, he added.

Further, even among patients with irritable bowel syndrome due to abnormal peristalsis or colon spasms, sigmoid adhesions may contribute to the severity of their symptoms.

"This study is too small to draw final conclusions about the role [deflecting sigmoid adhesions] play in women with pelvic pain, but it seems apparent to me that the entity needs to be studied further," he concluded.