Adhesions, General and After Surgery

Adhesions Overview

An adhesion is a band of scar tissue that binds 2 parts of your tissue that are not normally joined together. Adhesions may appear as thin sheets of tissue similar to plastic wrap or as thick fibrous bands.

The tissue develops when the body's repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation. Although adhesions can occur anywhere, the most common locations are within the stomach, the pelvis, and the heart.

  • Abdominal adhesions: Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery. Abdominal adhesions also occur in about 10% of people who have never had surgery.
    • Most adhesions are painless and do not cause complications. However, adhesions cause about 60% of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.
    • Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years. As scar tissue begins to restrict motion of the small intestines, passing food through the digestive system becomes progressively more difficult. The bowel may become blocked.
    • In extreme cases, adhesions may form fibrous bands around a segment of an intestine. This constricts blood flow and leads to tissue death.
  • Pelvic adhesions: Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder, and usually occur after surgery. Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions within the fallopian tubes. A woman's eggs pass through her fallopian tubes into her uterus for reproduction. Fallopian adhesions can lead to infertility and increased incidence of ectopic pregnancy in which a fetus develops outside the uterus. Endometriosis, a condition in which tissue normally found inside the uterus grows in other parts of the body such as the bowel or fallopian tubes, may also be caused by pelvic adhesions.
  • Heart adhesions: Scar tissue may form within the membranes that surround the heart (pericardial sac), thus restricting heart function. Infections, such as rheumatic fever, may lead to adhesions forming on heart valves and can lead to decreased heart efficiency.

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Adhesions Causes

Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, trauma, or radiation. Repair cells within the body cannot tell the difference between one organ and another. If an organ undergoes repair and comes into contact with another part of itself, or another organ, scar tissue may form to connect the 2 surfaces.

Adhesions Symptoms

Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly. As a result, people experience many complaints based on where an adhesion forms and what it may disrupt. Typically, adhesions show no symptoms and go undiagnosed.

Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.

  • Adhesions above the liver may cause pain with deep breathing.
  • Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
  • Adhesions involving the vagina or uterus may cause pain during intercourse.
  • Pericardial adhesions may cause chest pain.
  • It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
  • Small bowel obstruction (intestinal blockage) due to adhesions is a surgical emergency.
    • These adhesions may trigger waves of cramplike pain in your stomach. This pain, which can last seconds to minutes, often worsens if you eat food, which increases activity of the intestines.
    • Once the pain starts, you may vomit. This often relieves the pain.
    • Your stomach may become tender and progressively bloated.
    • You may hear high-pitched tinkling bowel sounds over your stomach, accompanied by increased gas and loose stools.
    • Fever is usually minimal.
  • Such intestinal blockage can sometimes correct itself. However, you must see your doctor. If the blockage progresses, these conditions may develop:
    • Your bowel stretches further.
    • Pain becomes constant and severe.
    • Bowel sounds disappear.
    • Gas and bowel movements stop.
    • Your belly becomes distended.
    • Fever may increase.
    • Further progression can tear your intestinal wall and contaminate your abdominal cavity with bowel contents.

When to Seek Medical Care

See a doctor any time you experience abdominal pain, pelvic pain, or unexplained fever. If you have undergone surgery or have a history of medical illness, discuss any changes in your recovery or condition with your doctor.

Call 911 and go to the nearest emergency department if chest pain occurs.

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Exams and Tests

Doctors typically diagnose adhesions during a surgical procedure such as laparoscopy (putting a camera through a small hole into the stomach to visualize the organs). If they find adhesions, doctors usually can release them during the same surgery.

Studies such as blood tests, x-rays, and CT scans may be useful to determine the extent of an adhesion-related problem. However, a diagnosis of adhesions usually is made only during surgery. A physician, for example, can diagnose small bowel obstruction but cannot determine if adhesions are the cause without surgery.

Adhesions Treatment - Self-Care at Home

Adhesions must be diagnosed and treated by a physician.

Medical Treatment

Treatment varies depending on the location, extent of adhesion formation, and problems the adhesion is causing. Adhesions frequently improve without surgery. Therefore, unless a surgical emergency becomes evident, a doctor may treat symptoms rather than perform surgery.

Surgery

Two common surgical techniques used to treat abdominal adhesions are laparoscopy and laparotomy.

  • With laparoscopy, a doctor places a camera into your body through a small hole in the skin to confirm that adhesions exist. The adhesions then are cut and released (adhesiolysis).
  • In laparotomy, a doctor makes a larger incision to directly see adhesions and treat them. The technique varies depending on specific circumstances.

Next Steps - Follow-up

If you have undergone surgery or have a history of medical illness, always discuss changes in your recovery or condition with your doctor.

Prevention

Steps are taken during surgery to try and minimize the formation of adhesions. Some of these may include: shortening surgical time, keeping the tissues moist, gentle handling of any tissues or organs, and using starch –free and latex-free gloves. Several surgical products have also been developed to try to help prevent adhesions from forming during surgery. Film-like sheets are sometimes used between organs or body surfaces after large, open surgical procedures.

Outlook

Adhesions requiring surgery commonly come back because surgery itself causes adhesions.

Synonyms and Keywords

adhesion, pelvic adhesion, heart adhesion, pericardial adhesion, intrauterine adhesion, tissue disturbance, surgery, infection, trauma, radiation, scar tissue, small-bowel obstruction, pelvic pain, chronic pelvic pain, intestinal adhesion, general adhesion, general adhesions, adhesion after surgery, adhesions after surgery, abdominal adhesion, adhesion causes, adhesion symptoms

WebMD Medical Reference Reviewed by Lisa Bernstein, MD on May 31, 2018

Sources

SOURCE:

Adhesions, General and After Surgery from eMedicineHealth

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