Adhesions (General and After Surgery)

An adhesion is a band of scar tissue that binds two parts of tissue or organs 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 abdomen, the pelvis, and the heart.

Abdominal adhesions: Abdominal adhesions are a common complication of surgery, occurring in a majority of people who undergo abdominal or pelvic surgery. Abdominal adhesions also occur in a small number of people who have never had surgery.

• Most adhesions are painless and do not cause complications. However, adhesions cause the majority 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 an entire segment of the intestine. This constricts blood flow and can lead 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, such as after C-section or hysterectomy. Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions in and around 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.

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 leading to decreased heart efficiency.

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 two surfaces.

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 due to blocking the passage of intestinal contents such as food or liquid or 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 may become a surgical emergency.
  • These adhesions trigger waves of cramp-like pain in the stomach. This pain, which can last seconds to minutes, often worsens when the person eats, which increases activity of the intestines.
  • Once the pain starts, the affected individual may vomit. This often relieves the pain.
  • The stomach may become tender and progressively bloated.
  • The person may hear high-pitched "tinkling" bowel sounds over the stomach, accompanied by increased gas and loose stools.
  • Fever is usually minimal or occurs later in the process.
  • Such intestinal blockage can correct itself. However, a person must see your doctor if the blockage progresses and conditions may develop:
    • The bowel stretches further
    • Pain becomes constant and severe
    • Bowel sounds disappear
    • Gas (flatulence) and bowel movements stop
    • The belly expands and swells
    • Fever may increase
    • Further progression can tear the intestinal wall (perforation) and contaminate the abdominal cavity with bowel contents.

See a doctor any time a person experiences abdominal pain that doesn't resolve quickly, pelvic pain, chest pain, or unexplained fever. If the person has undergone surgery or has a history of medical illness, discuss any changes in recovery or condition with a doctor.

If the person's abdominal pain is associated with high fever, continuous vomiting, swelling of the abdomen, chest pain, back pain, fainting or lightheadedness, gastrointestinal bleeding, go to the emergency department.

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. 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 must be diagnosed and treated by a physician.

Treatment varies depending on the location, extent of adhesion formation, and problems the adhesion is causing. Adhesions frequently improve without surgery. Unless a surgical emergency becomes evident, a doctor may treat symptoms rather than perform surgery. Pain treatment, IV fluids, antibiotics, and other symptomatic treatments are sometimes sufficient to allow the symptoms of the adhesion is causing to resolve on their own.

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.

If a person has undergone surgery or have a history of medical illness, discuss changes in recovery or condition with a doctor.

Several surgical products have been developed to prevent adhesions from forming during surgery. The effectiveness of these products is variable.

Adhesions requiring surgery commonly come back because surgery itself causes adhesions. When adhesions of bands are divided by cutting, electrical current or other methods, there will be two ends that have a potential to form further adhesions.