Adhesions

The tissue reaction to injury is called inflammation. Depending on the type of tissue involved and the amount of damage, the tissue may be completely restored to normal or scar tissue may form. Tissue injury can be caused by surgery, infection, trauma or radiation. An adhesion is a band of scar tissue that joins two separate internal body surfaces together. Adhesions usually occur between two serous membranes which are close together. A serous membrane is a thin cover of body tissue over internal body organs and cavities. It allows organs to move freely inside the body. An example of body parts covered by serous membranes are the:
Lungs
Heart
Abdominal organs
Cavities like the chest and abdomen.Adhesions can be as thin as plastic wrap or they may appear as thick, fibrous bands. Most adhesions are diagnosed during surgery. Your doctor may use x-rays or a CT scan to determine the extent of adhesion-related problems. Treatment may involve cutting and releasing the adhesions (adhesiolysis) during a laparoscopy procedure or treating the adhesions during a laparotomy.Problems associated with adhesionsThere are often no signs or symptoms associated with adhesions. However, adhesions can cause pain by pulling on nerves. For example, adhesions above the liver may cause pain with deep breathing, intestinal adhesions may cause pain during exercise or stretching, and adhesions around the heart may restrict its action. Common problems associated with adhesions include:
Abdominal adhesions - around 90 per cent of patients who undergo abdominal or pelvic surgery develop abdominal adhesions. Most adhesions are painless and do not cause complications. However, it is estimated that adhesions are responsible for more than 60 per cent of small bowel obstructions and contribute to the development of chronic pelvic pain. Adhesions that form in the abdomen may restrict motion of the small intestine, making it difficult for food to pass through the digestive system. The bowel may become blocked.
Pelvic adhesions - adhesions which involve the uterus, ovaries, fallopian tubes or bladder can form in the pelvis. Pelvic inflammatory disease (PID) can lead to the development of adhesions which affect the fallopian tubes as well as damaging their lining. This can lead to infertility and ectopic pregnancy.
Heart adhesions - can develop as a result of infections of the heart or rheumatic fever. Adhesions around the heart can lead to decreased heart efficiency.Medical issues to considerSince adhesions are likely to form after certain surgical procedures, adhesiolysis (surgical removal of adhesions), except for serious problems like bowel obstruction may be pointless. In around 70 per cent of cases, the operation to remove the original adhesions will cause more adhesions to develop. The risks, benefits and alternatives to surgery must be discussed thoroughly before any decision is made. Operation procedureThe cavity is opened and the adhesions cut and removed. In some cases, synthetic barriers may be inserted to prevent the healing tissues from sticking together with fibrous scar tissue. These barriers are like thin sheets of paper and are gradually absorbed by the body. Careful surgical techniques can greatly reduce the risk of adhesions reforming. These techniques include:
Avoid the introduction of foreign bodies into the cavity, such as powder from surgical gloves.
Limit unnecessary handling of the organs.
Avoid using dry sponges and make sure to irrigate the cavity during the surgical procedure.
Avoid unnecessary damage to organs, tissues and blood vessels.
Use the finest size suture thread appropriate to the surgery.Immediately after the operationYou will be regularly monitored by nursing staff. The time you spend in hospital depends on individual factors such as the type and length of surgery. Be advised by your doctor or surgeon.Possible complications of surgeryPossible complications include:
Injury to organs such as the bladder or bowel
Damage to the ureter
Injury to blood vessels and associated haemorrhage
Reformation of adhesions.Taking care of yourself at homeBe guided by your doctor or surgeon but general suggestions include:
Allow yourself sufficient time to recover from surgery. You may need help around the house for a time.
Follow any dietary instructions.
Avoid lifting heavy weights or climbing stairs if you have undergone abdominal surgery.
Be alert for any signs of infection. If you experience fever, pain, redness or swelling of the wound, contact your doctor immediately.Long term outlookAdhesions form after adhesiolysis in around 70 per cent of cases. You may need to be monitored by your doctor to see if any further adhesions develop.Other forms of treatmentResearch on other forms of treatment has returned inconsistent results. Certain drugs that may be used to control adhesions can cause unwanted - and even dangerous - side effects. Be guided by your health care professional. Apart from surgery, other options for treating adhesions may include:
Corticosteroids - to reduce inflammation.
Non-steroidal anti-inflammatory drugs (NSAIDS) - these drugs don’t contain steroids but still reduce inflammation.
Antihistamines - to reduce histamine release.Where to get help
Your doctorThings to remember
An adhesion is a band of scar tissue that joins two usually separate anatomic surfaces together.
The formation of scar tissue is the body’s repair mechanism response to tissue disturbance caused by surgery, infection, trauma or radiation.
Surgery to remove the adhesions (adhesiolysis) will cause more adhesions to form in around 70 per cent of cases.
Related articles:Endometriosis.Labial adhesions.Peritonitis.