(ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery
There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial.
Open surgery or laparoscopy are used without standardized indications.
Methods: A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus.Recommendations: In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, vascularisedbowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted.
These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution.
WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours.
After 72 hours of NOM without resolution surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions.
WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment.Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In highly selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique.
Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band.
A low threshold for open conversion should be maintained.Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions.
Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.
Author: Fausto CatenaSalomone Di SaverioMichael KellyWalter BifflLuca AnsaloniVincenzo MandalaGeorge VelmahosMassimo SartelliGregorio TugnoliMassimo LupoStefano MandalaAntonio PinnaPaul SugarbakerHarry Van GoorErnest MooreJohannes Jeekel
Credits/Source
Friday, February 11, 2011
Thursday, February 10, 2011
Peterson's Hernia after Gastric Bypass
A terrifying account of emergency adhesiolysis 10 years after a gastric bypass.
This was tricky. A middle aged lady ten years status post laparoscopic gastric bypass surgery (Roux en Y configuration) presented with crampy abdominal pain and nausea. Her plain films showed multiple dilated loops of small bowel. So I got a CT scan to better delineate the anatomy.
Bowel obstructions in Roux-n-Y gastric bypass patients always make me a little nervous. As opposed to garden variety, adhesion-mediated obstructions in people with normal anatomy, conservative treatment often fails in these patients. For one thing, you cannot adequately decompress them with nasogastric suction. Furthermore, the incidence of internal hernias is much higher, owing to the altered anatomy of the procedure (roux limbs and split mesenteries etc). So going into these cases, your threshold for surgery has to be exponentially higher than normal.
The scan above shows a subtle spiralling of some small bowel mesenteric vessels in the area where one would normally find the jejunojejunal anastomosis. Single views don't do the pathology justice; you really have to be able to scroll up and down through the loops of bowel on the scan. The patient looked uncomfortable, was tender, and I just didn't feel like dicking around for much longer. So I explored her in the OR.
She'd had two previous surgeries, prior to her gastric bypass even, for bowel obstructions secondary to an old hysterectomy, so things were pretty confusing, anatomically speaking, when I first entered her peritoneal cavity. The jejunojejunostomy appeared to be corkscrewed. That was clear enough from the beginning. Then I identified a decompressed limb of bowel going up to the gastric pouch (roux limb, a ha!). And then it looked like a bunch of small bowel had slipped through a space between the roux limb and the transverse mesocolon---classic Petersen's defect. Unfortunately, however, the bowel didn't want to slide back out of the space right away. It was stuck somewhere else further downstream. So I basically had to perform a full adhesiolysis of bowel, starting from terminal ileum and working back. To keep things organized, I literally had to place identifying stitches in the serosa of the proximal bowel as I flipped things back and forth. A couple of times it got a little hairy as the bowel started to turn bluish and I had to reverse my maneuvers, untwist things the correct way. Finally I freed everything up and the bulk of the small bowel was liberated, came rushing out from behind the defect. Looking down, the J-J anastomosis was normal again, the corkscrew configuration gone. I closed the defect, put in some voodoo-ish anti-adhesive Seprafilm and got the hell out.
Click on link to see imaging and read comments:
http://ohiosurgery.blogspot.com/2009/12/petersons-defect.html
This was tricky. A middle aged lady ten years status post laparoscopic gastric bypass surgery (Roux en Y configuration) presented with crampy abdominal pain and nausea. Her plain films showed multiple dilated loops of small bowel. So I got a CT scan to better delineate the anatomy.
Bowel obstructions in Roux-n-Y gastric bypass patients always make me a little nervous. As opposed to garden variety, adhesion-mediated obstructions in people with normal anatomy, conservative treatment often fails in these patients. For one thing, you cannot adequately decompress them with nasogastric suction. Furthermore, the incidence of internal hernias is much higher, owing to the altered anatomy of the procedure (roux limbs and split mesenteries etc). So going into these cases, your threshold for surgery has to be exponentially higher than normal.
The scan above shows a subtle spiralling of some small bowel mesenteric vessels in the area where one would normally find the jejunojejunal anastomosis. Single views don't do the pathology justice; you really have to be able to scroll up and down through the loops of bowel on the scan. The patient looked uncomfortable, was tender, and I just didn't feel like dicking around for much longer. So I explored her in the OR.
She'd had two previous surgeries, prior to her gastric bypass even, for bowel obstructions secondary to an old hysterectomy, so things were pretty confusing, anatomically speaking, when I first entered her peritoneal cavity. The jejunojejunostomy appeared to be corkscrewed. That was clear enough from the beginning. Then I identified a decompressed limb of bowel going up to the gastric pouch (roux limb, a ha!). And then it looked like a bunch of small bowel had slipped through a space between the roux limb and the transverse mesocolon---classic Petersen's defect. Unfortunately, however, the bowel didn't want to slide back out of the space right away. It was stuck somewhere else further downstream. So I basically had to perform a full adhesiolysis of bowel, starting from terminal ileum and working back. To keep things organized, I literally had to place identifying stitches in the serosa of the proximal bowel as I flipped things back and forth. A couple of times it got a little hairy as the bowel started to turn bluish and I had to reverse my maneuvers, untwist things the correct way. Finally I freed everything up and the bulk of the small bowel was liberated, came rushing out from behind the defect. Looking down, the J-J anastomosis was normal again, the corkscrew configuration gone. I closed the defect, put in some voodoo-ish anti-adhesive Seprafilm and got the hell out.
Click on link to see imaging and read comments:
http://ohiosurgery.blogspot.com/2009/12/petersons-defect.html
Monday, February 07, 2011
A Device Preemption Quickie -- Heisner v. Genzyme
In Heisner v. Genzyme, No. 08-C-593, 2009 U.S. Dist. LEXIS 37322 (N.D. Ill. Apr. 30, 2009), Heisner allegedly died as a result of an allergic reaction to Seprafilm, an anti-adhesive surgical barrier implanted in her body during a surgery. Seprafilm is a Class III medical device approved by the FDA through the premarket approval process.
Heisner's surviving spouse and estate filed the usual product liability claims against Genzyme, which manufactured Seprafilm. The trial court granted Genzyme's motion to dismiss on the ground of federal preemption.
Two items merit quick note: First, plaintiff asserted that his claims were "parallel" to, rather than "different from or in addition to" the federal requirements applicable to Seprafilm, because Genzyme had allegedly failed to report to the FDA (1) the death of plaintiff's decedent, and (2) a clinical trial protocol and related warnings finalized after Heisner's death. The trial court didn't have to address the "parallel requirements" issue, because events that took place after Heisner's death could not possibly have proximately caused Heisner's injury. Id. at *5.
Second, plaintiff's express warranty claims were based on statements made by Genzyme in (1) the package inserts for Seprafilm, and (2) the PMA protocol for certain Seprafilm clinical trials -- both of which had been approved by the FDA. Because the alleged warranties were based on statements that had been approved by the FDA, the court found those allegations of breach of warranty to be preempted. Id. at *8.
We'll include this one in the ever-expanding (New) Medical Device Preemption Scorecard.
Posted by Beck/Herrmann at 8:00 AM Labels: Medical Device, Preemption
Heisner's surviving spouse and estate filed the usual product liability claims against Genzyme, which manufactured Seprafilm. The trial court granted Genzyme's motion to dismiss on the ground of federal preemption.
Two items merit quick note: First, plaintiff asserted that his claims were "parallel" to, rather than "different from or in addition to" the federal requirements applicable to Seprafilm, because Genzyme had allegedly failed to report to the FDA (1) the death of plaintiff's decedent, and (2) a clinical trial protocol and related warnings finalized after Heisner's death. The trial court didn't have to address the "parallel requirements" issue, because events that took place after Heisner's death could not possibly have proximately caused Heisner's injury. Id. at *5.
Second, plaintiff's express warranty claims were based on statements made by Genzyme in (1) the package inserts for Seprafilm, and (2) the PMA protocol for certain Seprafilm clinical trials -- both of which had been approved by the FDA. Because the alleged warranties were based on statements that had been approved by the FDA, the court found those allegations of breach of warranty to be preempted. Id. at *8.
We'll include this one in the ever-expanding (New) Medical Device Preemption Scorecard.
Posted by Beck/Herrmann at 8:00 AM Labels: Medical Device, Preemption
Monday, January 31, 2011
Adhesion Awareness: A National Survey of Surgeons.
Schreinemacher MH, ten Broek RP, et al: World J Surg; 2010;34 (December): 2805-2812
Objective: To report on a survey of Dutch surgeons, hypothesizing that lack of knowledge about adhesions and their consequences is related to surgeon practice and adhesion-related complications.
Design: Survey.
Participants: 1455 surgeons and trainees.
Methods: Initial survey questions were developed by a group of surgeons with a particular interest in adhesions. Questions were then edited by researchers with expertise in survey design and construction of multiple choice questions. Resultant survey was pilot-tested with 5 practicing surgeons and 3 surgical trainees. Final survey contained 55 multiple-choice questions, 4 open-ended questions, and 4 optional questions. Survey was sent to all members of the Dutch Association for Surgery, as well as to all registered surgical trainees. A reminder was sent electronically 1 week after the initial email if no response was obtained. Data from surveys with <80% p ="0.032).">Conclusions: The magnitude of the problem of postoperative adhesions is underestimated.
Reviewer's Comments: None of the agents that have been proposed as the magic bullet to prevent adhesions has lived up to expectations (or hopes), although certain products are effective in certain high-risk operations and populations. Even if adhesions are viewed as an inevitable result, it does make sense to include this in the preoperative discussion with patients, particularly those in high-risk groups. It appears that hopes and expectations will continue to rest on a future magic bullet.(Reviewer–Karen J. Brasel, MD, MPH).
© 2010, Oakstone Medical Publishing
Source Link
Objective: To report on a survey of Dutch surgeons, hypothesizing that lack of knowledge about adhesions and their consequences is related to surgeon practice and adhesion-related complications.
Design: Survey.
Participants: 1455 surgeons and trainees.
Methods: Initial survey questions were developed by a group of surgeons with a particular interest in adhesions. Questions were then edited by researchers with expertise in survey design and construction of multiple choice questions. Resultant survey was pilot-tested with 5 practicing surgeons and 3 surgical trainees. Final survey contained 55 multiple-choice questions, 4 open-ended questions, and 4 optional questions. Survey was sent to all members of the Dutch Association for Surgery, as well as to all registered surgical trainees. A reminder was sent electronically 1 week after the initial email if no response was obtained. Data from surveys with <80% p ="0.032).">Conclusions: The magnitude of the problem of postoperative adhesions is underestimated.
Reviewer's Comments: None of the agents that have been proposed as the magic bullet to prevent adhesions has lived up to expectations (or hopes), although certain products are effective in certain high-risk operations and populations. Even if adhesions are viewed as an inevitable result, it does make sense to include this in the preoperative discussion with patients, particularly those in high-risk groups. It appears that hopes and expectations will continue to rest on a future magic bullet.(Reviewer–Karen J. Brasel, MD, MPH).
© 2010, Oakstone Medical Publishing
Source Link
Friday, January 28, 2011
Will liver scar tissue hurt my chances for a natural birth?
Asked by Inga Johnson, Lake Mary, Florida
"I had a liver resection in late December 2008 because of a cavernous hemangioma (an abnormal buildup of blood vessels). I now have about a 10-inch scar from about center of my rib cage following along to the outer ribcage. Are there known complications of scar tissue like this? I am eight weeks pregnant and have started to wonder if the scar tissue may be an issue for natural birth and if there may be other issues that I should be aware of."
Conditions Expert
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Expert answer
Of course, I encourage you to discuss your concerns with your obstetrician. Perhaps I can give you some information to help in that discussion.
First let me explain that a hepatic hemangioma (also referred to as cavernous hemangioma) is a very common benign liver tumor. It is not known why these tumors occur. They are found in men and women of all ages. They usually have no symptoms and are frequently found when CT scans and ultrasounds are done for unrelated reasons.
Small asymptomatic hemangiomas are usually watched. Larger (greater than 5 centimeter in diameter) and symptomatic hemangiomas are treated.
The most common treatment is surgical removal. When a hemangioma is successfully removed, the overwhelming majority of patients do very well. Some patients will have multiple hemangiomas and only the largest one or the one causing symptoms is removed.
For women who have a known moderate to large hemangioma, there is concern that the high estrogenic levels found in women who are pregnant or taking oral contraceptives may encourage the growth of these hemangiomas. This is a concern and not a certainty.
As a result, controversy exists as to whether patients with known hemangiomas should be advised against pregnancy. For patients with hepatic hemangioma, full-term pregnancy without complication is the norm, but there have been a small number of women with hemangiomas that rupture and bleed during pregnancy. Some of these ruptured hemangiomas can be carefully watched and some need surgical resection.
In answer to your question, all surgeries in which the abdomen is entered carry a risk of postoperative adhesions, or the bowel sticking to itself. This is true for an appendectomy, a gallbladder surgery or a liver surgery. The risk is greatest for open surgeries and lower for laparoscopic surgery.
In general, a healthy pregnant woman with a history of a hemangioma resection should do well with the pregnancy. The risk of complications in delivery, be it by natural childbirth or by cesarean section delivery, are similar to that of a woman having had any successful abdominal surgery.
Adhesions are the result of tissue trauma and subsequent healing. They can cause abdominal pain, infertility, bowel obstruction, and they can increase the difficulty of subsequent surgical procedures. Bowel obstruction is the most common concern. In one large study, 3 of every 100 patients having an open abdominal surgery were diagnosed with symptomatic adhesions. Most are diagnosed within the first year after surgery.
To understand adhesions and obstruction, picture the gastrointestinal tract. It is a long tubular structure running from the mouth to the anus. The large and small intestine is a part of that tract and runs more than 25 feet long in the average adult. Imagine the large and small intestine like a garden hose coiled up in the abdominal cavity. It is possible for some of the bowel to have folds stuck to itself that can at times, due to shifting and movement, impede the flow of bowel content.
Acute bowel obstruction due to adhesions usually manifests itself with abdominal pain, nausea and vomiting. It is usually treated with hydration and bowel rest and can resolve with no further ill effects. Severe obstruction and especially recurring obstruction may be treated with surgical removal of the blockage.
CNN
"I had a liver resection in late December 2008 because of a cavernous hemangioma (an abnormal buildup of blood vessels). I now have about a 10-inch scar from about center of my rib cage following along to the outer ribcage. Are there known complications of scar tissue like this? I am eight weeks pregnant and have started to wonder if the scar tissue may be an issue for natural birth and if there may be other issues that I should be aware of."
Conditions Expert
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Expert answer
Of course, I encourage you to discuss your concerns with your obstetrician. Perhaps I can give you some information to help in that discussion.
First let me explain that a hepatic hemangioma (also referred to as cavernous hemangioma) is a very common benign liver tumor. It is not known why these tumors occur. They are found in men and women of all ages. They usually have no symptoms and are frequently found when CT scans and ultrasounds are done for unrelated reasons.
Small asymptomatic hemangiomas are usually watched. Larger (greater than 5 centimeter in diameter) and symptomatic hemangiomas are treated.
The most common treatment is surgical removal. When a hemangioma is successfully removed, the overwhelming majority of patients do very well. Some patients will have multiple hemangiomas and only the largest one or the one causing symptoms is removed.
For women who have a known moderate to large hemangioma, there is concern that the high estrogenic levels found in women who are pregnant or taking oral contraceptives may encourage the growth of these hemangiomas. This is a concern and not a certainty.
As a result, controversy exists as to whether patients with known hemangiomas should be advised against pregnancy. For patients with hepatic hemangioma, full-term pregnancy without complication is the norm, but there have been a small number of women with hemangiomas that rupture and bleed during pregnancy. Some of these ruptured hemangiomas can be carefully watched and some need surgical resection.
In answer to your question, all surgeries in which the abdomen is entered carry a risk of postoperative adhesions, or the bowel sticking to itself. This is true for an appendectomy, a gallbladder surgery or a liver surgery. The risk is greatest for open surgeries and lower for laparoscopic surgery.
In general, a healthy pregnant woman with a history of a hemangioma resection should do well with the pregnancy. The risk of complications in delivery, be it by natural childbirth or by cesarean section delivery, are similar to that of a woman having had any successful abdominal surgery.
Adhesions are the result of tissue trauma and subsequent healing. They can cause abdominal pain, infertility, bowel obstruction, and they can increase the difficulty of subsequent surgical procedures. Bowel obstruction is the most common concern. In one large study, 3 of every 100 patients having an open abdominal surgery were diagnosed with symptomatic adhesions. Most are diagnosed within the first year after surgery.
To understand adhesions and obstruction, picture the gastrointestinal tract. It is a long tubular structure running from the mouth to the anus. The large and small intestine is a part of that tract and runs more than 25 feet long in the average adult. Imagine the large and small intestine like a garden hose coiled up in the abdominal cavity. It is possible for some of the bowel to have folds stuck to itself that can at times, due to shifting and movement, impede the flow of bowel content.
Acute bowel obstruction due to adhesions usually manifests itself with abdominal pain, nausea and vomiting. It is usually treated with hydration and bowel rest and can resolve with no further ill effects. Severe obstruction and especially recurring obstruction may be treated with surgical removal of the blockage.
CNN
Tuesday, January 25, 2011
Acute kidney injury due to osmotic nephrosis following intraoperative placement of an intraperitoneal antiadhesive barrier.
Am J Kidney Dis. 2011 Feb;57(2):304-7.
Acute kidney injury due to osmotic nephrosis following intraoperative placement of an intraperitoneal antiadhesive barrier.
Economidou D, Stavrinou E, Giamalis P, Dimitriadis C, Economou S, Memmos D.
Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
Abstract
In recent years, a common strategy for the prevention of postsurgical intra-abdominal adhesions has been intrasurgical placement of adhesion barriers into the peritoneal cavity. Osmotic agents, such as various polysaccharides, frequently are used as antiadhesive materials. The effects of these materials on kidney function have not yet been studied. We report a case of an individual with pre-existing chronic kidney disease who developed acute kidney injury after surgical placement of an antiadhesive barrier of macromolecular polysaccharides. A kidney biopsy, performed because of persistent kidney failure, showed tubular cell lesions compatible with osmotic nephrosis lesions. This case suggests that use of polysaccharide-containing antiadhesive barriers can induce severe kidney damage. Such barriers should be used with caution in patients with abnormal kidney function to prevent irreversible damage.
Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
PMID: 21251542 [PubMed - in process]
LinkOut - more resources
Acute kidney injury due to osmotic nephrosis following intraoperative placement of an intraperitoneal antiadhesive barrier.
Economidou D, Stavrinou E, Giamalis P, Dimitriadis C, Economou S, Memmos D.
Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
Abstract
In recent years, a common strategy for the prevention of postsurgical intra-abdominal adhesions has been intrasurgical placement of adhesion barriers into the peritoneal cavity. Osmotic agents, such as various polysaccharides, frequently are used as antiadhesive materials. The effects of these materials on kidney function have not yet been studied. We report a case of an individual with pre-existing chronic kidney disease who developed acute kidney injury after surgical placement of an antiadhesive barrier of macromolecular polysaccharides. A kidney biopsy, performed because of persistent kidney failure, showed tubular cell lesions compatible with osmotic nephrosis lesions. This case suggests that use of polysaccharide-containing antiadhesive barriers can induce severe kidney damage. Such barriers should be used with caution in patients with abnormal kidney function to prevent irreversible damage.
Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
PMID: 21251542 [PubMed - in process]
LinkOut - more resources
Monday, July 19, 2010
Adhesions, Adhesions-Related Disorder or CAPPS – a way to think about the problem from the patient’s perspective.
Adhesions, Adhesions-Related Disorder or CAPPS – a way to think about the problem from the patient’s perspective.
Dallas TX. June 11 2010. The International Adhesions Society (IAS) is proud to post on its adhesions.org web site the results of groundbreaking and innovative research which will forever change the way the problem of adhesions is viewed.
The paper was published after Dr. Wiseman was invited to submit a manuscript for inclusion in a special volume of “Seminars in Reproductive Medicine” on the subject of adhesions. The paper is entitled: “Disorders of Adhesions or Adhesion-Related Disorder: Monolithic Entities or Part of Something Bigger—CAPPS? “ (click here for .pdf)
Since forming the International Adhesions Society (IAS) in 1996, it became increasingly obvious that the problems of patients suffering from adhesions were not just about adhesions. Accordingly, we were the first to coin the term “Adhesion Related Disorder” (ARD) to include the entire complex of pain, infertility, obstruction, nutrition, psychological and social issues that ARD sufferers and their families experience.
Based on formal patient surveys as well as thousands of emails and phone calls from patients, it became apparent to us that even the term ARD may be inadequate to address the problem. In reality, the ARD patient is part of a much larger group of patients who, in varying degrees, combinations and sequences experience a range of symptoms and conditions including endometriosis, interstitial cystitis (IC), irritable bowel syndrome (IBS), bowel obstruction and chronic abdominal and/or pelvic pain.
Although ‘‘adhesions’’ may start out as a single, stand-alone entity, an adhesions patient may develop a number of related conditions (ARD) which renders those patients practically indistinguishable from patients with multiple symptoms originating from other abdominal or pelvic conditions. (continued)
release.
Click here for a pdf copy of the entire press
Click here for a .pdf copy of the CAPPS article
Please visit the Internation Adhesion Society to interact and become educated!
www.adhesions.org
Dallas TX. June 11 2010. The International Adhesions Society (IAS) is proud to post on its adhesions.org web site the results of groundbreaking and innovative research which will forever change the way the problem of adhesions is viewed.
The paper was published after Dr. Wiseman was invited to submit a manuscript for inclusion in a special volume of “Seminars in Reproductive Medicine” on the subject of adhesions. The paper is entitled: “Disorders of Adhesions or Adhesion-Related Disorder: Monolithic Entities or Part of Something Bigger—CAPPS? “ (click here for .pdf)
Since forming the International Adhesions Society (IAS) in 1996, it became increasingly obvious that the problems of patients suffering from adhesions were not just about adhesions. Accordingly, we were the first to coin the term “Adhesion Related Disorder” (ARD) to include the entire complex of pain, infertility, obstruction, nutrition, psychological and social issues that ARD sufferers and their families experience.
Based on formal patient surveys as well as thousands of emails and phone calls from patients, it became apparent to us that even the term ARD may be inadequate to address the problem. In reality, the ARD patient is part of a much larger group of patients who, in varying degrees, combinations and sequences experience a range of symptoms and conditions including endometriosis, interstitial cystitis (IC), irritable bowel syndrome (IBS), bowel obstruction and chronic abdominal and/or pelvic pain.
Although ‘‘adhesions’’ may start out as a single, stand-alone entity, an adhesions patient may develop a number of related conditions (ARD) which renders those patients practically indistinguishable from patients with multiple symptoms originating from other abdominal or pelvic conditions. (continued)
release.
Click here for a pdf copy of the entire press
Click here for a .pdf copy of the CAPPS article
Please visit the Internation Adhesion Society to interact and become educated!
www.adhesions.org
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