The adhesions or adhesions pelvic and abdominal are tissue adhesions occurring in organs of the abdomen and pelvic area , usually related to surgery, gynecological or inflammatory diseases .
What are tissue adhesions?
The tissue adhesions consist of bands of scar tissue formed abnormally joining areas that should not be connected, both the same organ as different bodies.
Scar tissue is completely normal in the wound healing process, but can sometimes appear in adjacent areas, especially in the presence of inflammation, and gives rise to so-called adhesions or tissue adhesions.
Pelvic and abdominal adhesions are defined as tissue adhesions that appear within the intestine or uterus or between the surface of the abdominal organs and the peritoneum .
Adhesions displace the organs from their normal position and this can obstruct the passage of food or blood flow, cause pain, constipation, urinary retention or even infertility.
Causes of pelvic and abdominal adhesions
The most common causes of pelvic and abdominal adhesions are related to surgical interventions , inflammatory diseases, infections, or other diseases such as cancer or endometriosis .
Many types of surgical interventions can produce adhesions as a side effect or complication .
For example, operations for appendicitis, gallbladder, any operation in the intestine and stomach, cesarean section, ectopic pregnancies or any other major operation in the pelvic and abdominal area, can have this side effect.
Certain gynecological interventions , for example uterine curettage or curettage , can produce intrauterine adhesions .
Various chronic diseases can cause abdominal adhesions, such as appendicitis, Crohn’s disease, ulcerative colitis or any pelvic inflammatory disease (infections or inflammation in the uterus, ovaries or other organs of the female reproductive system).
The infections in the abdominal and pelvic region frequently cause the formation of adhesions, especially secondary infections in wounds, including wounds of surgical procedures, and secondary infections to other diseases.
- Bacterial infections secondary to Crohn’s disease can cause abscesses around the intestinal wall and the formation of adhesions, especially around the rectum and anus.
- Sexually transmitted diseases (STDs) : Chlamydia and gonorrhea can result in the formation of adhesions in various organs of the pelvis and abdomen, such as the uterus, fallopian tubes and ovaries, and cause chronic pain , irregular periods and even ectopic pregnancies.
- Intestinal tuberculosis
- Surgical wound infection
Other causes of pelvic and abdominal adhesions include:
- Internal bleeding from intestinal perforation
- Cancer and tumor formations
- Radio and chemotherapy
- Although rare, some congenital deformities and diseases can produce adhesions present from birth
- Asherman’s syndrome
Main symptoms of pelvic adhesions
The symptoms caused by adhesions depend fundamentally on its location and the organs and tissues involved. Among the most common symptoms are abdominal pain, pelvic pain, loss of appetite, nausea, and vomiting .
The most important complications that adhesions can generate are:
- Intestinal obstruction : the fibrous tissue of the adherence can obstruct the intestine, or if the adherence is on the intestinal surface, it can displace the intestine from its normal position and twist it, making it difficult for intestinal transit. This causes loss of appetite, dry skin and mouth, intense thirst, nausea, vomiting, constipation, abdominal bloating, cramps, etc.
- Strangulation : adhesions can strangle the intestine and cause intestinal volvulus . The blood supply to the affected area can be compromised, even causing gangrene.
- Infertility : adhesions in the fallopian tubes or in the uterus can make pregnancies unviable and lead to infertility.
- Ectopic Pregnancies : Adhesions in the fallopian tubes increase the risk of ectopic pregnancies.
In the medium and long term, adhesions can result in chronic pain , generally worse when walking or in certain postures, and gastroesophageal reflux is also frequent . The obstruction or pressure on the urinary system can generate, depending on the situation, very frequent urination or urinary retention . Loss of appetite can lead to anemia and deficiencies of other nutrients.
All these symptoms can affect the personal, family and social life of the patient, including severe depression and loss of employment due to the disability caused by the symptoms.
The most effective treatment for adhesions is a surgical procedure called adhesiolysis . Scalpel, laser, or electrosurgery can be used. The goal is to remove adhesion and force a new healing process.
Adhesiolysis has a high degree of effectiveness but can result in new adhesions , so it is only performed in severe cases, in which there is intestinal obstruction or in which there are other symptoms that require it.
To prevent adhesions from forming, the least invasive surgical procedures should be chosen whenever possible, for example laparoscopy rather than open surgery.
They can also be prevented by impregnating the tissue surfaces with agents that prevent the formation of adhesions, for example gels with hyaluronic acid or anti-inflammatory steroid drugs.