Adhesions. Introduction Adhesions are bands of scar tissue. They form between tissues and organs. Most adhesions form after surgery in the abdomen.

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1 Adhesions Introduction Adhesions are bands of scar tissue. They form between tissues and organs. Most adhesions form after surgery in the abdomen. Some adhesions don't cause any problems. But adhesions can pull sections of the intestines out of place, twisting them and making them narrower. This may block food from passing through the intestine and cause digestive problems. In women, pelvic adhesions may cause fertility problems. This reference summary will help you better understand adhesions. It also discusses their symptoms, causes and treatment. Adhesion Adhesions Internal tissues and organs normally have slippery surfaces. This allows them to shift and glide past each other easily when the body moves. Adhesions are bands of scar tissue. They form on organs in the abdomen, chest or pelvis. This causes the organs to stick to one another. It can also cause organs to stick to other tissues in the body, such as the wall of the abdomen. Most adhesions cause no symptoms or problems. But others can cause chronic abdominal or pelvic pain. Adhesions are also a major cause of intestinal obstruction. 1

2 Abdominal adhesions can kink, twist or pull the intestines out of place. This can cause an intestinal obstruction. An intestinal obstruction may partially or fully stop food or stool from moving through the intestines. A complete intestinal obstruction is life threatening. Adhesions may cause infertility in women. They may prevent fertilized eggs from reaching the uterus, by kinking or twisting the Fallopian tubes. These tubes carry eggs from the ovaries, where eggs are stored and released, to the uterus. The uterus is where a fetus grows and develops. Symptoms Most adhesions go unnoticed. But sometimes they cause symptoms. Adhesions can cause pain by pulling nerves. The pain that a person experiences depends on the location of the adhesions. The most common symptom caused by adhesion is chronic pain in the abdominal or pelvic region. The pain is similar to that of appendicitis, endometriosis and diverticulitis. Appendicitis is a blockage inside of the appendix. The appendix is a small, tube-like organ attached to the first part of the large intestine. It is located in the lower right part of the abdomen. Endometriosis is a condition in which the tissue lining the uterus grows in abnormal places in the abdomen. Diverticulitis is the inflammation of one or more pouches or sacs that bulge out from the wall of a hollow organ, such as the colon. Adhesions are most often found in the abdomen. These adhesions can cause an intestinal obstruction. This can be life threatening. 2

3 Symptoms of intestinal obstruction include: Severe abdominal cramping and pain. Vomiting. Bloating. Loud bowel sounds. Swelling of the abdomen. Inability to pass gas. Constipation. Severe intestinal obstruction may lead to dehydration. Symptoms of dehydration include: Dry skin. Dry mouth and tongue. Severe thirst. Infrequent urination. Fast heart rate. Low blood pressure. Sometimes an area of intestine that is affected by adhesions can become blocked then unblocked. This can cause symptoms to come and go. Adhesions can also be found in other parts of the body. Heart adhesions may cause chest pain. Adhesions above the liver may cause pain with deep breathing. Intestinal adhesions may cause pain when stretching or during exercise. Adhesions that affect the vagina or uterus may cause pain during sex. Causes Adhesions form when the body tries to repair itself. They develop after tissue in the body is disturbed, such as during surgery. The cells that repair tissue in the body may connect two surfaces that come into contact with one another. The cells cannot tell one organ from another. This causes scar tissue, or adhesions. 3

4 Abdominal surgery is the most frequent cause of abdominal adhesions. Almost everyone who has abdominal surgery develops them. The risk for developing adhesions is greatest after operations on the lower abdomen and pelvis. Adhesions can start to form right after surgery. But they can become larger and tighter as time passes. Symptoms may not be noticed until years after surgery. Adhesions may also be caused by inflammation from sources not related to surgery. But this is less common. Other causes of adhesions are: Abdominal infections. Appendicitis or appendix rupture. Infections of the female reproductive organs. Radiation treatment for cancer. Diagnosis To diagnose adhesions, your health care provider will ask you questions about your medical history. He or she will perform a physical exam. Adhesions cannot be seen through imaging techniques such as x-rays or ultrasound. But these tests and others may be used to rule out other causes of your symptoms. Abdominal adhesions may cause an intestinal obstruction. An intestinal obstruction can be seen through: X-rays. Barium contrast studies, also known as lower GI series. Barium contrast studies are x-rays of the colon and rectum. They are taken after a person is given a barium enema. Computerized tomography, also known as a CAT scan or CT scan. Computerized tomography creates a series of detailed pictures of areas inside the body. The pictures are taken from different angles. 4

5 Most adhesions are found during exploratory surgery. Treatment Treatment for abdominal adhesions is usually not necessary. Most adhesions do not cause problems. Medicines to relieve pain are sometimes enough to treat symptoms. Other medicines may also be used, depending on the symptoms. A partial intestinal obstruction can sometimes be treated with a liquid or a low residue diet. A low residue diet is high in dairy products and low in fiber. It is more easily broken down into smaller particles by the digestive system. Surgery is the only way to treat adhesions that cause chronic pain, intestinal obstruction or infertility. But most surgery carries the risk of causing more adhesions. A complete intestinal obstruction usually requires immediate surgery. Laparoscopy and laparotomy are used to treat abdominal adhesions. During laparoscopy, a camera is moved through a small hole in the abdomen. The adhesions then are cut and released. In laparotomy, a health care provider makes an incision to directly see adhesions and treat them. Adhesions often come back after surgery. This is because surgery itself causes adhesions. Summary Adhesions are bands of scar tissue. They form between tissues and organs. Most adhesions form after surgery on the abdomen. Adhesions may also be caused by inflammation from sources not related to surgery. But this is less common. 5

6 Most adhesions don't cause any problems. But some adhesions can twist, kink and pull sections of the intestines out of place. This may block food from passing through the intestine and cause digestive problems. In women, pelvic adhesions may cause fertility problems. Surgery is the only way to treat adhesions that cause chronic pain, intestinal obstruction or infertility. But most surgery carries the risk of causing more adhesions. Treatment for abdominal adhesions is usually not necessary. Medicines to relieve pain are sometimes enough to treat symptoms. A partial intestinal obstruction can sometimes be treated with a liquid or a low residue diet. 6

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