Which history increases the risk of intra-abdominal adhesions?

• A. History of peritonitis
• B. Chronic pancreatitis
• C. Acute appendicitis resolved
• D. No prior surgeries

Answer: (A)

Peritoneal injury or inflammation triggers adhesion formation. When the peritoneum is damaged, inflammatory processes promote fibrin deposition; if that fibrin isn’t fully resolved, it can organize into fibrous bands that stick loops of bowel or other organs together. Peritonitis, an infection of the peritoneal lining, causes widespread peritoneal inflammation and injury, so it dramatically increases the likelihood of these fibrous adhesions forming. That’s why a history of peritonitis is the history most strongly associated with a higher risk of intra-abdominal adhesions.

The other options don’t carry the same risk. Pancreatitis is inflammation of the pancreas and surrounding tissues but is less typically a peritoneal surface injury that leads to abdominal adhesions. A resolved acute appendicitis may have involved peritoneal irritation, but if there was no peritoneal infection or surgical intervention, adhesions are not as likely. Having no prior surgeries means there’s had to be no prior peritoneal injury from operative manipulation, which keeps the risk of adhesions low.