Intestinal adhesions are fibrous bands that tether loops of bowel to each other or to the abdominal wall, most commonly arising after peritoneal injury from surgery, infection, or radiation. Symptoms reflect the degree of luminal compromise, vascular impedance, and risk of strangulation.

1. Colicky abdominal pain
   Intermittent, cramping pain coincides with peristaltic waves against a fixed point; pain is typically periumbilical or suprapubic and may be relieved transiently by positional change.
2. Distension and tympany
   Partial or complete obstruction prevents effective passage of flatus and stool, leading to visible abdominal distension, hyper-resonant percussion, and high-pitched metallic bowel sounds.
3. Nausea and bilious vomiting
   Vomiting becomes faeculent in complete distal obstruction; bilious emesis without prior oral intake indicates high-grade small-bowel block.
4. Absolute constipation
   Failure to pass flatus or stool (“obstipation”) is pathognomonic for complete obstruction; partial occlusion allows intermittent passage with residual bloating.
5. Localised tenderness and guarding
   Focal rebound pain over an adhesive band or prior incision site suggests impending bowel ischemia; diffuse tenderness with board-like rigidity raises concern for perforation.
6. Reversible partial episodes
   Patients often report recurrent self-limiting attacks (“adhesive crises”) lasting hours to days, separated by asymptomatic intervals.
7. Alarm signs of strangulation
   Persistent pain despite nasogastric decompression, tachycardia, fever, leukocytosis, or metabolic acidosis mandates urgent operative evaluation to prevent bowel infarction.