37 y.o. female with ability to form intra-abdominal adhesion | Figure 1

Case Report

Patient Information
37 y.o. female with the ability to form intra-abdominal adhesions.

Past Medical History
Significant for hereditary pancreatitis - repeated pancreatitis at a young age requiring Puestow procedure at age 8.
Currently taking Pancreatic Enzyme Replacement with meals.
Also on suboxone therapy for pain related to chronic pancreatitis and escitalopram.

Surgical History

• 3 episodes of small bowel volvulus since 2020 requiring surgical detorsion.
• 3 years ago - laparotomy with detorsion.
• 2 months ago - laparotomy with detorsion and tacking of the peritoneum of the small bowel mesentery down to the peritoneum of the left-sided mesocolon with 2 sutures to prevent recurrence.
• Last month - laparotomy with detorsion; absence of peritoneal tissue to use as a tacking mechanism.

Clinical Findings
During her last surgery last month, the surgeon noted a complete absence of intra-abdominal adhesions despite her 3 past abdominal surgeries and feels that her inability to produce adhesions will likely lead to a recurrence of volvulus.

Review of Systems and Examination
Nothing to suggest a hereditary or autoimmune connective tissue disease or malabsorption/malnutrition.
No arthritis/rash/bleeding disorder/cardiorespiratory symptoms/myalgia/edema.
No hypermobility/skin laxity, or delayed wound healing.

Laboratory Results
Labs including CBC/Creat/E+/LFT/TSH/HBA1c/INR/PTT/Albumin all normal. I am awaiting serum levels of fat-soluble vitamins.

Discussion

Can anyone think of a reason why this young patient is unable to produce intra-abdominal adhesions? This would normally not be a problem but happens to be detrimental in her case and puts her at greater risk of recurrent small bowel volvulus.

Thank you.