Adhesive Syndrome

What is adhesive syndrome?

Adhesive syndrome is a set of symptoms that occur because intra-abdominal adhesions form, usually intraperitoneal. They are bands of scar tissue fibers that can form on the surface of different tissues, between them and the peritoneum or they can also be mixed. Adhesions are formed by collagen and can “glue” different structures or parts of them inside the pelvis. An example is the colon and the uterus, or the colon and the ovaries, or the fallopian tubes. All of these will lead to functional alterations and pain in the patient.

Most of these adhesions can form after operations or due to infections and are part of the healing process. However, they cause the union of structures that, under normal conditions, should not be joined.

Adhesive syndrome is more common in women, due to abdominopelvic adhesions, which are the most common due to pathologies and gynecological-obstetric surgeries. Also, most of the affected people are between 25 and 50 years old.

Adhesions can be of different types:

Depending on the origin:

  • Congenital
  • Acquired

According to the anatomical location:

  • Visceral-visceral
  • Visceral-parietal
  • Visceral-epiploic
  • Epiploic-parietal

According to their pathogenesis:

  • Following non-traumatic, ischemic or inflammatory events.
  • After physical trauma or surgical manipulation

Adhesions are usually caused by inflammatory processes or surgery.

Prognosis of the disease

Adhesive syndrome can be serious, as structures that should not be together are sticking together. This will not only cause pain in the patient but will affect the function of organs and structures.

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Symptoms of adhesive syndrome

Adhesive syndrome manifests differently depending on the location and rigidity of the adhesions. The most common symptom is abdominal pain related to a history of pelvic abdominal surgery. If, in addition, there is intestinal obstruction, the patient may also present:

  • Vomiting and nausea
  • Abdominal distention
  • Failure to pass gas and stool

Medical tests for adhesive syndrome

The diagnosis will be based, above all, on the suspicion of the specialist in Gynecology and Obstetrics, in most cases. Based on the patient’s history of pelvic surgery or inflammation, as well as endometriosis, he or she may consider adhesions to be present. In this sense, a transvaginal ultrasound will allow a first diagnosis, allowing to see the organs and their location. However, it may not be entirely accurate.

The Digestive System specialist may also order some tests based on the digestive symptoms suffered by the patient.

What are the causes of adhesive syndrome?

Most adhesions form after operations or due to infections, as part of the healing process. This usually occurs when they are performed openly, in open surgeries such as laparotomy, ovarian surgery or appendectomy in a state of advanced inflammation. However, other inflammatory processes related to pelvic inflammatory disease or endometriosis can also cause adhesions.

Can it be prevented?

The way to prevent adhesive syndrome is to try to minimize surgical trauma after an operation, something that specialists in General Surgery will do:

  • Minimize the use of lasers, retractors and cautery.
  • Avoid ischemia and desiccation.
  • Use laparoscopy as much as possible.
  • Use barrier gels and membranes that separate the operated surfaces, preventing adhesions from forming.
  • Careful handling of the tissues.
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Treatments for adhesive syndrome

The treatment of adhesive syndrome will depend on the symptoms presented by the patient. Thus, if there is no intestinal obstruction, it can be treated:

  • Drinking plenty of fluids.
  • Performing cardiovascular exercise.
  • Avoiding the ingestion of astringent foods.
  • Occasionally using laxatives.

If there is intestinal obstruction, a conservative treatment based on the decompression of the digestive tract with intravenous solutions and nasogastric tube will be used.

If the obstruction is very important, another surgery, laparoscopic adhesiolysis, will be recommended. With this technique the adhesions will be properly diagnosed, in what degree they are and if it compromises the rest of the structures of the pelvic cavity. The technique allows, therefore, to free the structures that were attached.

Which specialist treats it?

Different specialists can treat adhesion syndrome, depending on the location, size and extent of the adhesions, as well as the state they are in and the symptoms they are causing in the patient. If the adhesions are located in the pelvis and the patient is a woman, the specialist in Gynecology and Obstetrics will be in charge of the diagnosis and follow-up. However, if the adhesions also cause symptoms in the digestive tract, it will be the specialist in this area who should address it, with the most conservative diagnosis and treatment as far as possible. Finally, when one of these specialists considers that there are no other treatment options, it will be the specialist in General Surgery, or the gynecologist himself, who will have to perform a surgical intervention.