Abdominal adhesions are the most common complications following abdominal surgery, with an incidence rate of up to 90%, especially in complex abdominal diseases such as intestinal fistula, where extensive and dense adhesions are more likely to form. Precise assessment of abdominal adhesions is crucial for optimizing treatment and reducing the risk of complications. Current methods for evaluating abdominal adhesions include clinical assessment, imaging evaluation, laboratory marker detection, and surgical exploration. Clinical assessment provides clues about adhesions through medical history collection and physical examination but struggles to accurately determine the location and severity of adhesions. Among imaging evaluations, ultrasound can display the movement of intra-abdominal organs and visceral sliding signs but performs poorly in visualizing deep adhesions; conventional computed tomography (CT) can only indirectly suggest the presence of adhesions; dynamic magnetic resonance imaging (Cine MRI) can achieve an accuracy rate of up to 90% by capturing dynamic organ activities. Laboratory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) correlate with adhesion severity but lack specificity. Although surgical exploration is the “gold standard”, it is not suitable for routine diagnosis due to its invasiveness. Abdominal adhesion scoring systems include the American Society for Reproductive Medicine adhesion classification, the Nair scoring system, and the Clinical Adhesion Score (CLAS). The latter integrates multidimensional parameters such as adhesion-related complications and reoperation difficulty, with an inter-observer reliability of up to 0.95. Precise assessment of abdominal adhesions can guide surgical approach selection, predict the risk of postoperative complications, and direct anti-adhesion strategy application. Future research directions include integrating multi-omics analysis to explore specific molecular networks, establishing comprehensive multi-modal data evaluation systems, developing risk-stratified assessment systems, and researching novel anti-adhesion materials and drugs. Despite certain progress in the assessment of abdominal adhesion, there remain challenges including low sensitivity, insufficient specificity, and the lack of unified standards. Developing precise, non-invasive or minimally invasive assessment methods, establishing risk prediction models, and promoting clinical translational research are key to improving patient clinical outcomes.