| Adhesion (medicine) | |
|---|---|
| Classification and external resources | |
Adhesions after appendectomy |
|
| 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 that connect tissues not normally connected.
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Adhesions form as a natural part of the body’s healing process after surgery in the same way that a scar forms. The term "adhesion" is applied when the scar extends from within one tissue across to another, usually across a virtual space such as the peritoneal cavity. As part of the process, the body deposits fibrin onto injured tissues. The fibrin acts like a glue to seal the injury and builds the fledgling adhesion, said at this point to be "fibrinous." In body cavities such as the peritoneal, pericardial and synovial cavities, a family of fibrinolytic enzymes may act to limit the extent of the initial fibrinous adhesion, and may even dissolve it. In many cases however the production or activity of these enzymes are compromised because of injury, and the fibrinous adhesion persists. If this is allowed to happen, tissue repair cells such as macrophages, fibroblasts and blood vessel cells, penetrate into the fibrinous adhesion, and lay down collagen and other matrix substances to form a permanent fibrous adhesion.
While some adhesions do not cause problems, others can prevent muscle and other tissues and organs from moving freely, sometimes causing organs to become twisted or pulled from their normal positions.
In the case of adhesive capsulitis of the shoulder (also known as frozen shoulder), adhesions grow between the shoulder joint surfaces, restricting motion.
Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures but may also be caused by pelvic inflammatory disease or endometriosis. The adhesions start to form within hours 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. A SBO may be caused when an adhesion pulls or kinks the small intestine and prevents the flow of content through the digestive tract. It 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. SBO is an emergent, possibly fatal condition without immediate medical attention. According to statistics provided by the National Hospital Discharge Survey approximately 2,000 people die every year in the USA from obstruction due to adhesions.[2] Depending on the severity of the obstruction, a partial obstruction may relieve itself with conservative medical intervention. However, many obstructive events require surgery to lyse the offending adhesion(s) or resect the affected small intestine.
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.[3] 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 British medical journal The 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.[4] Over 22% of all readmissions occurred in the first year after the initial surgery.[4] Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures.[5]
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.[6]
Types of 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.[7] 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.[7] All study participants had histories indicating abdominopelvic adhesion formation.[7]
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