Adhesion (medicine)

Adhesion (medicine)


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Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue. In the case of frozen shoulder (also known as adhesive capsulitis) adhesions grow between the shoulder joint surfaces, restricting motion.

Adhesions form as a natural part of the body’s healing process after surgery. As part of the process, the body deposits fibrin onto injured tissues. The fibrin acts like a glue to seal the injury and encourage deposition of cellular matrix, but may also cause tissues that should be separate to adhere to one another, held together by an adhesion. Over time, as part of the healing process, the body will either break down the adhesion and replace it with normal tissue or form a permanent adhesion.

Some adhesions do not cause problems. Adhesions can prevent tissues and organs from moving freely, however, sometimes causing organs to become twisted or pulled from their normal positions. Abdominal adhesions are most commonly caused by abdominal surgical procedures, but may also be caused by pelvic inflammatory disease such as endometriosis. The adhesions form within seven days after surgery and may cause internal organs to attach to the surgical site or to other organs in the abdominal cavity. Adhesion-related twisting and pulling of internal organs can result in complications such as infertility and chronic pelvic pain. Surgery inside the uterine cavity (eg. suction D&C, myometcomy, endometrial ablation) can result in Asherman's Syndrome also known as intrauterine adhesions, a cause of infertility.

Small bowel obstruction (SBO) is another significant consequence of post-surgical adhesions. An SBO may be caused when an adhesion pulls or kinks the small intestine and prevents the flow of content through the digestive tract. Such an event could occur 20 years or more after the initial surgical procedure, if a previously benign adhesion should allow the small bowel to spontaneously twist around itself and obstruct. A SBO is often an emergent condition that could result in death without immediate medical attention. Depending on the severity of the obstruction, a partial obstruction may relieve itself with conservative medical intervention. However, many obstructive events will require re-operation to lyse the offending adhesion(s) or resect the affected small intestine.

As well, adhesions from prior abdominal or pelvic surgery can obscure visibility and access at subsequent abdominal or pelvic surgery. Published reports suggest that a majority of patients that undergo abdominopelvic surgery will be readmitted for surgery within ten years for related or unrelated conditions. [Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynec. 1994;170(5);1396-1403] Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures. [Van der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MMPJ, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87;467-471.]

Prior to the availability of adhesion barriers, adhesions were documented to be an almost unavoidable consequence of abdominal and pelvic surgery, and occurred in as much as 93% of all patients undergoing abdominal surgery. [ [ American Society of Reproductive Medicine] ]

External links

* [ The UK Adhesions Society]

* [ eMedicineHealth: Adhesions, General and After Surgery]
* [ GPnotebook]
* [ Abdominal Adhesions]
* [ International Support Group for Asherman's Syndrome (intrauterine adhesions)]

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