Pathophysiology of Intestinal Obstruction due to Postoperative Adhesions in Humans: An Integrative Review with a Translational Perspective
DOI:
https://doi.org/10.66201/ss.v1.18Keywords:
Peritoneal Adhesions, Intestinal Obstruction, Pathophysiology, Fibrinolysis, Intestinal Ischemia, Mesothelial Cells, Integrative ReviewAbstract
Introduction: Postoperative peritoneal adhesions constitute the leading cause of acquired intestinal obstruction worldwide. Their pathophysiology involves a cascade of molecular events that begins with injury to the peritoneal mesothelium and culminates, in the most severe cases, in transmural ischemia and intestinal necrosis. Understanding these mechanisms is essential for developing effective preventive and therapeutic strategies. The objective of this study was to synthesize the available evidence on the central pathophysiological mechanisms of intestinal obstruction due to postoperative adhesions in humans, ranging from initial peritoneal injury to mechanical obstruction and its ischemic consequences.
Methods: An integrative review was conducted following the Whittemore and Knafl model, with a systematic search in PubMed/MEDLINE, Cochrane, Embase, and Web of Science (January 2020–March 2026). Nineteen studies were included, selected for their relevance to pathophysiological mechanisms in adult humans, including experimental models with explicit translational correlation.
Results: Five interconnected pathophysiological axes were identified: 1) deregulation of the fibrinolysis/fibrogenesis balance, with predominance of plasminogen activator inhibitor type 1 (PAI-1) over tissue plasminogen activator (tPA); 2) an inflammatory cascade mediated by peritoneal macrophages, interleukins, and tumor necrosis factor-alpha (TNF-α); 3) mesothelial-mesenchymal transition (MMT) driven by transforming growth factor-beta 1 (TGF-β1) and tissue hypoxia; 4) oxidative stress with the generation of reactive oxygen species (ROS) and activation of pro-adhesive transcription factors; and 5) progressive intestinal ischemia due to mesenteric vascular compression, leading to eventual transmural necrosis and bacterial translocation.
Conclusions: Intestinal obstruction due to postoperative adhesions results from a pathophysiological continuum integrating inflammatory, fibrinolytic, molecular, and ischemic mechanisms. Mastery of these mechanisms guides therapeutic interventions targeted at specific points in the pathological cascade.
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Copyright (c) 2026 Fernanda Dillenburg da Costa, Beatriz Barbosa Oliveira, Beatriz Cassiano De Moraes Silva, Cibelly Assunção Santos, Daniel Henrique Santos Siade, Ingrid Gontijo Takahashi, Josenice Deladia Cerqueira, Letícia Diniz De Souza Braga, Luciana Polak Schener, Priscila De Paula Pereira Malta, Ynabla Santos Santiago, Andrea Paola Britos de Chaux (Autor/a)
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