The peritoneum is a membrane that lines the pelvic and abdominal walls and covers the organs within the cavities. An adhesion, involving the peritoneum in the abdominal cavity, is a band of fibrous material holding two parts together that usually would be separated. This peritoneal adhesion may cause a bowel obstruction or a kink in the intestine.

Adhesions occur after peritonitis associated with perforation of the bowel. Some examples of inflammation that may perforate and cause peritonitis are diverticulitis, appendicitis, and pancreatitis. Blunt trauma to the abdomen may cause perforation or rupture, e.g., injuries resulting from steering wheels, or bicycle handlebars.

A bowel obstruction results in manifestations including: pain; fever; abdominal distention; either increased or absent bowel sounds; obstipation; and nausea with vomiting. Systemic symptoms of small bowel obstruction are more serious than those of the large bowel. Symptoms may decrease if the bowel is released from the obstructing band and only a partial obstruction remains. If the blood supply to the bowel is intact, it is termed a simple obstruction. When the bowel becomes strangulated, resulting in the venous and arterial blood supplies being cut off the bowel turns gangrenous. This results in an emergency situation.

Routine laboratory work-ups are done in the presence of the inflammatory conditions that preceded the adhesion formation. Abdominal x-rays, endoscopy and barium studies will demonstrate intestinal distention or organ rupture.

The adhesions are surgically resected to prevent recurrence or obstruction.

When an abdominal surgical procedure is performed to release adhesions, the patient will have an incision and undergo a postoperative recovery period. There is the possibility that a colostomy will be done. This procedure will require the patient to wear an appliance or drainage bag to contain stool, and to learn the self-care necessary to function in this situation. The colostomy may be temporary or permanent.

• None.

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. [38 CFR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.114.  [38 CFR 4.113]