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Adhesion

Definition

Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together.

As the body moves, tissues or organs inside are normally able to shift around each other. This is because these tissues have slippery surfaces.

Alternative Names

Pelvic adhesion; Intraperitoneal adhesion; Intrauterine adhesion

Causes, incidence, and risk factors

Inflammation (swelling), surgery, or injury can cause adhesions to form almost anywhere in the body, including:

  • In joints such as the shoulder
  • In the eyes
  • Inside the abdomen or pelvis

Once they form, adhesions can become larger or tighter over time. Symptoms or other problems may occur if the adhesions cause an organ or body part to twist, pull out of position, or be unable to move as well.

The risk of forming adhesions is high after bowel or female organ surgeries. Surgery using a laparoscope is less likely than open surgery to cause adhesions.

Other causes of adhesions in the abdomen or pelvis:

  • Appendicitis, most often when the appendix breaks open (ruptures)
  • Cancer
  • Endometriosis
  • Infections in the abdomen and pelvis
  • Radiation treatment

Adhesions around the joints may happen:

  • After surgery or trauma
  • With certain types of arthritis
  • With overuse of a joint or tendon

Symptoms

Adhesions in joints, tendons, or ligaments make it harder to move the joint and may cause pain.

Adhesions in the belly (abdomen) that caused a kink, twist, or pulling may cause a blockage of the intestines. Symptoms include:

  • Bloating or swelling of your belly
  • Constipation
  • Nausea and vomiting
  • No longer being able to pass gas
  • Pain in the belly that is severe and crampy

Adhesions in the pelvis may cause chronic or long-term pelvic pain.

Signs and tests

Most of the time, the adhesions cannot be seen using x-rays or imaging tests.

  • Hysterosalpingography may help diagnose adhesions inside the uterus or Fallopian tubes.
  • X-rays of the abdomen, barium contrast studies, and CT scans may help diagnose a blockage of the intestines caused by adhesions.
Endoscopy (a way of looking inside the body using a flexible tube that has a small camera on the end) may help diagnose adhesions:
  • Hysteroscopy looks inside the uterus
  • Laparoscopy looks inside the abdomen and pelvis

Treatment

Surgery may be done to separate the adhesions. This often allows normal movement of the organ and reduces the symptoms caused by the adhesion. However, the risk for more adhesions increases as the number of surgeries increases.

Depending on the location of the adhesions, at the time of surgery a barrier can be placed to try to reduce the chance of the adhesions returning.

See also: Intestinal obstruction repair

Expectations (prognosis)

The outcome is usually good.

Complications

Depending on the tissues involved, adhesions can cause various disorders.

  • In the eye, adhesion of the iris to the lens can lead to glaucoma.
  • In the intestines, adhesions can cause partial or complete bowel obstruction.
  • Adhesions inside the uterine cavity, called Asherman syndrome, can cause a woman to have irregular menstrual cycles and be unable to get pregnant.
  • Pelvic adhesions that involve scarring of the fallopian tubes can lead to infertility and reproductive problems.
  • Abdominal and pelvic adhesions can cause chronic pain.

Calling your health care provider

Call your health care provider if you have:

  • Abdominal pain
  • An inability to pass gas
  • Nausea and vomiting that do not go away
  • Pain in the belly that is severe and crampy

References

Munireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. Surg Clin N Am. 2010;90:1227–1236

Kulaylat MN, Dayton, MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL,eds. Sabiston Textbook of Surgery. 18th ed.Philadelphia, Pa: Saunders Elsevier; 2007:chap 15.

Paine R. Rehabilitation and therapeutic modalities: a language of exercise and rehabilitation. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 5 section A.

Review Date: 2/26/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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