Presentation
It usually remains asymptomatic in mild cases, but if severe, may present with chronic and vague RUQ abdominal pain which may be intermittent or persistent. [ncbi.nlm.nih.gov]
Entire Body System
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Pain
Symptoms of the condition can include bowel obstruction, chronic pain, female infertility and, sometimes, death. [upi.com]
Long term follow-up at 3.7 years showed that 33% who underwent adhesiolysis were totally pain-free, 46% had less pain, and the rest did not experience improvement. [ncbi.nlm.nih.gov]
She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before. CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. [websurg.com]
Peridural adhesions [ edit ] Adhesions and scarring as epidural fibrosis may occur after spinal surgery that restricts the free movement of nerve roots, causing tethering and leading to pain. [en.wikipedia.org]
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Physician
"This is a very common surgical complication, but it's not been well-studied," said Jonathan Tsai, a resident physician at Brigham and Women's Hospital and study co-author. [upi.com]
*Medscape Business of Medicine Academy Survey, September 2015 Learn from Experienced Professionals Courses were developed especially for physicians by business health experts and experienced physicians. [login.medscape.com]
PMID 19912289. a b c American Academy of Orthopaedic Surgeons (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely : an initiative of the ABIM Foundation, American Academy of Orthopaedic Surgeons, retrieved 19 May 2013 [en.wikipedia.org]
In such instances, laparoscopy can confirm or modify the diagnosis, change management and outcome, and/or provide peace of mind to the patient, the family, and the treating physician. [ncbi.nlm.nih.gov]
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Infertility
Symptoms of the condition can include bowel obstruction, chronic pain, female infertility and, sometimes, death. [upi.com]
suction dilation and curettage, myomectomy, endometrial ablation ) may result in Asherman's syndrome (also known as intrauterine adhesions, intra uterine synachiae), a cause of infertility. [en.wikipedia.org]
- Female infertility and dyspareunia. - Rectal bleeding and dyschezia (i.e. painful defecation) during menses, which typically indicate colorectal involvement of endometriosis [8]. [ncbi.nlm.nih.gov]
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Surgical Procedure
Abdominal adhesions [ edit ] Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures. [en.wikipedia.org]
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Inflammation
This often causes inflammation and causes fibrin deposits onto the damaged tissues. [2] The fibrin then connects the two adjacent structures where damage of the tissues occurred. [en.wikipedia.org]
Gastrointestinal
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Abdominal Pain
Keywords: Laparotomy, Laparoscopic surgery, Intestinal obstruction, Adhesiolysis, Abdominal pain 1. [ncbi.nlm.nih.gov]
She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before. CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. [websurg.com]
Adhesion-related twisting and pulling of internal organs may result in complications such as abdominal pain or intestinal obstruction. Small bowel obstruction (SBO) is a significant consequence of post-surgical adhesions. [en.wikipedia.org]
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Dyspepsia
Empiric and symptomatic treatment such as those available for dyspepsia (e.g. simethicone, proton pump inhibitors, nortriptyline) are often attempted but are of variable efficacy, depending on the extent to which symptoms are attributable to adhesions [ncbi.nlm.nih.gov]
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Constipation
- Altered bowel habits, including constipation or frequent loose stools (e.g. from development of small intestinal bacterial overgrowth). - Nausea with or without early satiety. - Bowel obstruction, which may be transient, partial, or complete (and [ncbi.nlm.nih.gov]
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Nausea
In a small but clinically significant proportion of patients, adhesive disease may develop, wherein adhesions lead to a variety of chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern which can be daily, intermittent [ncbi.nlm.nih.gov]
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Chronic Abdominal Pain
Laparoscopy Effective for Management of Chronic Abdominal Pain; pp. 14–15. [ Google Scholar ] 20. Paajanen H., Julkunen K., Waris H. Laparoscopy on chronic abdominal pain. A prospective Nonrandomized long-term follow up study. J. Clin. [ncbi.nlm.nih.gov]
Cardiovascular
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Thrombosis
Dextran has been used successfully to prevent thrombosis of small arteries and large veins following trauma to the intima. 4,5 The mechanism by which dextran prevents thrombosis remains obscure. The total plasma volume [jamanetwork.com]
Liver, Gall & Pancreas
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Hepatomegaly
Imaging studies on the other hand will show abnormalities such as increased liver echotexture on ultrasound or hypodensity on computed tomography, often with hepatomegaly. - Other disorders: Atypical presentation of peptic ulcer disease, small bowel strictures [ncbi.nlm.nih.gov]
Skin
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Ulcer
- Other disorders: Atypical presentation of peptic ulcer disease, small bowel strictures, GI tract tumors, small bowel diverticula, Celiac disease, inflammatory bowel disease, chronic mesenteric ischemia, pancreatobiliary disorders (e.g. choledocholithiasis [ncbi.nlm.nih.gov]
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Night Sweats
On the other hand, clinical features such as unexplained weight loss, fever, and night sweats should dissuade against adhesions as the primary etiology. [ncbi.nlm.nih.gov]
Musculoskeletal
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Frozen Shoulder
Regions affected [ edit ] Adhesive capsulitis [ edit ] In the case of adhesive capsulitis of the shoulder (also known as frozen shoulder), adhesions grow between the shoulder joint surfaces, restricting motion. [en.wikipedia.org]
Psychiatrical
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Suggestibility
In 2002, Giuseppe Martucciello's research group showed a possible role could be played by microscopic foreign bodies (FB) inadvertently contaminating the operative field during surgery. [3] These data suggested that two different stimuli are necessary [en.wikipedia.org]
For example, in a study assessing the long-term outcomes of elective laparoscopic adhesiolysis in those with chronic GI symptoms, 70% achieved complete adhesiolysis, and 80% experienced complete resolution of symptoms suggesting that even partial adhesiolysis [ncbi.nlm.nih.gov]
Urogenital
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Pelvic Pain
In women they typically affect reproductive organs and thus are of concern in reproduction or as a cause of chronic pelvic pain. Other than surgery, endometriosis and pelvic inflammatory disease are typical causes. [en.wikipedia.org]
Adhesions in patients with chronic pelvic pain: a role for adhesiolysis? Fertil. Steril. 2004; 82 (6):1483–1491. [ PubMed ] [ Google Scholar ] 23. Easter D.W., Cuscieri A., Nathanson L.K. [ncbi.nlm.nih.gov]
Workup
Ultrasound
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Enlargement of the Liver
The pathogenesis of pain in fatty liver is thought to be related to stretching of Glisson's capsule due to the enlarged liver. The liver function tests can be normal or up to three times normal. [ncbi.nlm.nih.gov]
Colonoscopy
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Colitis
Crohns Colitis. 2013 Jul; 7 (6):467–473. [ PubMed ] [ Google Scholar ] 13. Tingsted B., Isakson J., Anderson R. Long term follow up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions. Br. J. [ncbi.nlm.nih.gov]
Treatment
The NIH places the annual cost of post-surgical adhesion treatment as high as 1 billion. [upi.com]
The lack of amenability of all adhesions to surgical treatment cannot be overemphasized. [ncbi.nlm.nih.gov]
"American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome". The Journal of Bone and Joint Surgery. American Volume. 92 (1): 218–9. doi : 10.2106/JBJS.I.00642. [en.wikipedia.org]
Etiology
Nevertheless, as mentioned earlier, abdominal imaging is valuable to rule out other etiologies for a patient's symptoms. [ncbi.nlm.nih.gov]
"Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management". Digestive Surgery. 18 (4): 260–73. doi : 10.1159/000050149. [en.wikipedia.org]
Pathophysiology
Pathophysiology [ edit ] Adhesions form as a natural part of the body’s healing process after surgery in a similar way that a scar forms. [en.wikipedia.org]
Pathophysiology and prevention of postoperative peritoneal adhesions. World J. Gastroenterol. 2011 Nov 7; 17 (41):4545–4553. [ PMC free article ] [ PubMed ] [ Google Scholar ] 29. [ncbi.nlm.nih.gov]
Prevention
When abnormal fibrous connections known as adhesions grow, they can bind organs to the abdominal wall following surgery, preventing the organs from sliding around as they should. [upi.com]
"Adhesion prevention: a standard of care". Medical Association Communications. American Society of Reproductive Medicine. February 2002. a b "Adhesion Prevention: A Standard of Care". American Society for Reproductive Medicine. [en.wikipedia.org]
Dextran has been used successfully to prevent thrombosis of small arteries and large veins following trauma to the intima. 4,5 The mechanism by which dextran prevents thrombosis remains obscure. The total plasma volume [jamanetwork.com]
Prevention of postoperative peritoneal adhesions: a review of the literature. AMJ Surg. 2011 Jan; 201 (1):111–121. [ PubMed ] [ Google Scholar ] 32. [ncbi.nlm.nih.gov]