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Adhesion (medicine)
Classification and external resources
ICD-10 K56.5, N73.6, N99.2, N99.4
ICD-9 560.81, 614.6
MedlinePlus 001493
MeSH D000267

Adhesions are fibrous bands[1] that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue.

Contents

Pathophysiology

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.

While some adhesions do not cause problems, others can prevent tissues and organs from moving freely, sometimes causing organs to become twisted or pulled from their normal positions.

Regions affected

Adhesive capsulitis

In the case of frozen shoulder (also known as adhesive capsulitis) adhesions grow between the shoulder joint surfaces, restricting motion.

Abdominal adhesions

Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures but may also be caused by pelvic inflammatory disease. 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 (e.g., suction D&C, myomectomy, 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. An SBO can occur 20 years or more after the initial surgical procedure, if a previously benign adhesion allows 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.

Association with surgery

A study in Digestive Surgery showed that more than 90% of patients develop adhesions following open abdominal surgery and 55%–100% of women develop adhesions following pelvic surgery.[2] Adhesions from prior abdominal or pelvic surgery can obscure visibility and access at subsequent abdominal or pelvic surgery. In a very large study (29,790 participants) published in the British medical journal Lancet, 35% of patients who underwent open abdominal or pelvic surgery were readmitted to the hospital an average of two times after their surgery due to adhesion-related or adhesion-suspected complications.[3] Over 22% of all readmissions occurred in the first year after the initial surgery.[3] Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures.[4]

Before 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.[5]

Types

Types of adhesions:

  1. Fibrinous adhesions. They are causes of early postoperative obstruction which settles down within 3-5 days. Majority of them will disappear in due course of time.
  2. Fibrous adhesions. If the infection is continuous or if foreign is present, the finrous material is converted into fibrous material.

Nonsurgical treatment for adhesions

A manual manipulative physical therapy (The Wurn Technique) applied to the body’s soft tissues, has been examined as a nonsurgical treatment to decrease adhesions causing pain, infertility, or dysfunction. In a 2004 peer-reviewed study on the rate of natural pregnancy within one year for infertile women who received the Wurn Technique (average infertility five years), 71% [10/14] became pregnant.[6] In a second peer-reviewed study in 2004, the therapy improved pregnancy rates for women undergoing in vitro fertilization (IVF) procedures. Women who received the therapy within 15 months before an IVF transfer had a 67% pregnancy rate vs. the 41% US Center for Disease Control national average for IVF.[6] All study participants had histories indicating abdominopelvic adhesion formation.[6]

ACOG board certified gynecologist and study co-author, Richard King, MD, says that the therapy is appropriate for women with confirmed or suspected abdominopelvic adhesions. Prior surgery, infection, inflammation, or trauma in this area [abdomen or pelvis] are all reasons for suspicion of adhesions.[7]

References

  1. ^ adhesion at Dorland's Medical Dictionary
  2. ^ Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance. Dig Surg. 2001; 18: 260-273. PMID 11528133.
  3. ^ a b Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet Br J Med. 1999; 353: 1476-80. PMID 10232313.
  4. ^ 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. PMID 10759744.
  5. ^ Adhesion prevention: a standard of care. 1999 - 2003 Medical Association Communications. American Society of Reproductive Medicine. http://www.cmecorner.com/macmcm/asrm/asrm2002_02.htm
  6. ^ a b c Wurn BF, Wurn LJ, King CR, Heuer MA, Roscow AS, Scharf ES, Shuster JJ. Treating Female Infertility and Improving IVF Pregnancy Rates with a Manual Physical Therapy Technique. Med. Gen. Med. 2004 Jun 18; 6(2): 51. PMID 15266276.
  7. ^ Burnette, A. Physical Therapy to Improve IVF Pregnancy Rates. Achieving Families. 2005, Sept: 30.

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