adhesion

my brother had a tumor removed from his rectum/colon.   He got through the surgery and went home and had radiation and chemo treatments.    He started having severe pain in his stomach and throwing up and went to the hospital where they waited for a week before performing surgery to remove an obstruction which turned out to be adhesions in his small intestine.     He went home after a week in the hospital and went home.    A day or so after getting home he started suffering from high fevers which went down after giving him tylenol.   After 3-4 days of this he went back to the hospital where they did another ct and found he had more adhesions.   It has now been seven days since he was admitted and they are supposed to operate again today.    Is this the proper procedure to wait this long before surgery?    My brother is very weak and has lost alot of weight. Should we be seeking another opinion?    The doctor told him adhesions like this are very rare and only happen to about 1% of patients.    What could be causing this?    Is the treatment not correct for him and should it be changed.    
    

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Your brothers' multiple adhesions may have resulted from scarring caused by surgery, or due to radiation.
The timing of the surgery actually depends on the patients clinical findings. Many surgeons give a trial of conservative management, especially if the obstruction is 'subacute'. Here, they restrict oral intake, and give IV fluids. If this trial fails, then they operate and relieve the obstruction surgically.