Pelvic/abdominal adhesions develop from peritonial injury. Radiation, infection and operative trauma are some of the causes that can create adhesions. Adhesions can also be congenital. About 8% of adhesions form without the patient having had surgery. They are scars made of fibrous tissue that can form an abnormal bond betsurgeonen two structures not normally joined.
Because they connect organs and tissue that are normally separated, they can lead to pain and a variety of complications for the patient.
Symptoms of adhesions may include, but are not limited to, the following:
- - Pain
- - Bloating
- - Nausea
- - Difficulties in bosurgeonl movements
- - Diarrhea
- - Dehydration
- - Dyspareunia (painful intercourse)
- - Uncomfortable urination
To exclude other causes of symptoms so that surgeon can diagnose adhesions, some of the following tests can be used:
- - A CT scan of the abdomen can exclude hernias and some tumors
- - An Ultrasound can diagnose endometriosis, ovarian cysts, or gallstones.
- - An Enteroclysis can evaluate the involvement of the small bosurgeonl in the adhesion process
After all of these tests, if a diagnosis has not been established, a laparoscopy might be used to correlate the location of adhesions and the location of pain.
Sometimes the adhesions can be so dense and widespread that at present surgery is not feasible, but surgeon can help the patient maintain a good quality of life until science had advanced enough that they can be cured. In other cases because the patient has had surgery and has been said to have adhesions, anything that is wrong with the patient is blamed on adhesions. Adhesions may indeed be present, but may not be the main or the only cause of suffering. The evaluation of the patient might follow the lines of detective work to determine what is causing the symptoms and suffering. It might not always be adhesions. The evaluation might involve additional doctors and different specialties It could be a gynecological problem such as ovarian cysts or endometriosis. It could be a urological problem, such as interstitial cystitis. It could be a surgical problem unrelated to adhesions such as gallbladder disease, incisional hernias or abdominal neuropathy. It could be gastroenterological condition such as irritable bowel, colitis, or a bowel motility problem such as pseudo-obstruction of the colon.
In a third group of patients the symptoms come from adhesions and only adhesions. Surgery might be laparoscopic or it might be an open operation. It might be one operation or a series of surgeries. Evaluation must be complete and a plan made achieving steady progress in the care of the patient. Usually the treatment for adhesions need not be very extensive. Between 70% and 80% of patients with abdominal and pelvic adhesions can be treated laparoscopically. This involves a short stay in the hospital with an average discharge time of 23 hours after surgery. Patients have found this to be very acceptable treatment. Some patients though, will need a laparotomy; possibly with a follow-up laparoscopy.
Surgery is done with the purpose not only to cut the adhesions, but also to prevent them from reforming. One study showed what happens to patients who simply have a lysis of adhesions without any attempt to prevent reattachment. Over 50 women had laparoscopic lysis of adhesions done. About three months later, a second laparoscopy was done. The second looks showed that 97% of the time adhesions of one kind or another had reformed. It is for this reason why simply dividing the adhesions without trying to prevent recurrence gives only temporary relief. This is also the reason why most surgeons avoid electively operating on adhesions.