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Adhesion

Pelvic adhesion; Intraperitoneal adhesion; Intrauterine adhesion

 

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

Causes

 

With movement of the body, internal organs such as the bowel or uterus are normally able to shift and to slide past each other. This is because these tissues and organs in the abdominal cavity have smooth, slippery surfaces. Inflammation (swelling), surgery, or injury can cause adhesions to form and prevent this movement. Adhesions can occur almost anywhere in the body, including:

  • Joints, such as the shoulder
  • Eyes
  • Inside the abdomen or pelvis

Adhesions can become larger or tighter over time. Problems may occur if the adhesions cause an organ or body part to:

  • Twist
  • Pull out of position
  • Be unable to move normally

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

Other causes of adhesions in the abdomen or pelvis include:

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

Adhesions around the joints may occur:

  • 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. They may also cause pain.

Adhesions in the belly (abdomen) 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 long-term (chronic) pelvic pain.

 

Exams and Tests

 

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

  • Hysterosalpingography may help detect adhesions inside the uterus or fallopian tubes.
  • X-rays of the abdomen, barium contrast studies, and CT scans may help detect 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 can let the organ regain normal movement and reduce symptoms. However, the risk for more adhesions goes up with more surgeries.

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

 

Outlook (Prognosis)

 

The outcome is good in most cases.

 

Possible Complications

 

Adhesions can cause various disorders, depending on the tissues affected.

  • 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 can cause a condition called Asherman syndrome. This 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.

 

When to Contact a Medical Professional

 

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

Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 12.

Nakamura N, Rodeo SA, Alini M, Maher S, Madry H, Erggelet C. Physiology and pathophysiology of musculoskeletal tissues. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 1.

National Institute of Diabetes and Digestive and Kidney Diseases website. Abdominal adhesions. www.niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions. Updated September 2013. Accessed February 19, 2018.

Text only

 
  • Pelvic adhesions

    Pelvic adhesions - illustration

    Pelvic adhesions are bands of scarlike tissue that form between two surfaces inside the body. Inflammation from infection, surgery, or trauma can cause tissues to bond to other tissues or organs.

    Pelvic adhesions

    illustration

  • Ovarian cyst

    Ovarian cyst - illustration

    An ovarian cyst is a sac filled with fluid, or a semisolid material, that develops on or within the ovary. Ovarian cysts are relatively common and usually disappear without treatment.

    Ovarian cyst

    illustration

    • Pelvic adhesions

      Pelvic adhesions - illustration

      Pelvic adhesions are bands of scarlike tissue that form between two surfaces inside the body. Inflammation from infection, surgery, or trauma can cause tissues to bond to other tissues or organs.

      Pelvic adhesions

      illustration

    • Ovarian cyst

      Ovarian cyst - illustration

      An ovarian cyst is a sac filled with fluid, or a semisolid material, that develops on or within the ovary. Ovarian cysts are relatively common and usually disappear without treatment.

      Ovarian cyst

      illustration

     

    Review Date: 1/14/2018

    Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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