Manual Physical Therapy for Non-Surgical Treatment of Adhesion-Related Small Bowel Obstructions: Two Case Reports

Abstract

Background: Adhesion formation is a widely acknowledged risk following abdominal or pelvic surgery. Adhesions in the abdomen or pelvis can cause or contribute to partial or total small bowel obstruction (SBO). These adhesions deter or prevent the passage of nutrients through the digestive tract, and may bind the bowel to the peritoneum, or other organs. Small bowel obstructions can quickly become life-threatening, requiring immediate surgery to resect the bowel, or lyse any adhesions the surgeon can safely access. Bowel repair is an invasive surgery, with risks including bowel rupture, infection, and peritonitis. An additional risk includes the formation of new adhesions during the healing process, creating the potential for subsequent adhesiolysis or SBO surgeries. Objective: Report the use of manual soft tissue physical therapy for the reversal of adhesion-related partial SBOs, and create an initial inquiry into the possibility of nonsurgical lysis of adhesions. Case Reports: Two patients presenting with SBO symptoms due to abdominal adhesions secondary to abdominal and pelvic surgery were treated with manual soft tissue physical therapy focused on decreasing adhesions. Conclusions: Successful treatment with resolution of symptom presentation of partial SBO and sustained results were observed in both patients treated.

Treating Small Bowel Obstruction with a Manual Physical Therapy: A Prospective Efficacy Study

“…Mobility was restored at the most superficial tissues using myofascial release [ 32 ]. Adhesions within and between organs and in interstitial spaces within the viscera were addressed using the Wurn Technique [ 29 ]. Decreased organ motility was addressed using visceral manipulation [ 32 ].…”

“…Manual physical therapy (mPT) is used to treat adults with a wide variety of adhesive conditions including burns, adhesive capsulitis, radiculopathy, pain, infertility, and lessening of scars [ 14 – 24 ] and has shown promise in preventing adhesion formation in animal models [ 25 , 26 ]. The Clear Passage Approach (CPA), a mPT protocol hypothesized to deform the adhesions that cause SBO episodes, has been demonstrated previously in case reports to negate the need for surgery in patients with recurrent SBOs and other adhesion related diseases [ 27 – 29 ].…”

Palliative Care Symptom Management

“…25,26 In patients who suffer from recurrent adhesive-related small bowel obstruction, who are not surgical candidates, preventive and therapeutic measures may include abdominal or visceral massage therapy. 27 …”

Manual physical therapy clears adhesive bowel obstruction and strictures in a patient with Crohn’s disease

“…[26][27][28][29][30][31][32][33] Furthermore, the manual physiotherapy regimen utilized in the current study, CPA, has previously been shown effective in disrupting adhesions, decreasing pain, and improving the overall quality of life in patients with recurrent SBO. [34][35][36][37] CPA integrates techniques from an array of manual modalities to optimize individualized treatment, focusing intently on the patient's specific areas of restriction. Application of a variety of sitespecific pressures across restrictive bands of adhered tissues and structures are employed, progressing from superficial to deep tissues.…”

“…Preferring to pursue non-operative management, she sought out alternative therapy via an Internet search. She came across a manual physiotherapy known as the Clear Passage Approach (CPA) which has previously been shown to decrease abdominopelvic adhesions [34][35][36][37].…”