Postoperative adhesions: causes, dangers and treatment
Postoperative adhesions is a dense connective tissue formation in the abdominal or pelvic cavity between the internal organs. They are formed at the site of injury, inflammation, and constitute a kind of protective reaction of the body — the attempt to limit the source of the disease. Adhesions disrupt the normal functioning of the abdominal organs and lead to serious complications.
Why are the spikes?
Connective tissue bands (adhesions) in the abdominal or pelvic cavity are formed as a consequence of surgical intervention or as a response to inflammatory processes in this area. The body builds up extra tissue, secretes a sticky fibrin glues to each other located close to the surface, trying to keep a diseased organ or to stop the spread of inflammation. Adhesions can be in the form of scars, filaments or films connecting adjacent organs and intestinal loops.
The reasons for the formation of adhesive strands:
- tissue damage due to surgical interventions (laparoscopy, laparotomy);
- inflammation of the Appendix and the operation for its removal (appendectomy), divertikulita;
- abortion, uterine curettage, cesarean section;
- prolonged use of intrauterine contraceptive devices;
- hemorrhage into the body cavity;
- inflammatory diseases of the abdominal and pelvic cavities, including STDs.
Postoperative adhesive disease caused by tissue injury, hypoxia, ischemia, or drying, as well as getting into the body cavity of foreign matter of some chemical substances (particles of talc, fibers of the gauze).
What is the danger of adhesions?
Normally, the abdominal cavity and the pelvic cavity is movable. Intestinal loops may shift in the process of digestion, but their movements are not impeded transportation okulirovka ovum in the fallopian tube, and increasing during pregnancy, the uterus has no critical impact on the bladder.
The resulting scars, limiting inflammation, preventing normal mobility of organs and the carrying out of their functions. Adhesions may cause acute intestinal obstruction or the development of female infertility. In some cases the formation of adhesions does not cause the person discomfort and discomfort, but most of the adhesive disease is accompanied by severe pain syndrome.
Symptoms of pathology
The manifestation of the disease depends on the degree of its development. Can take place the individual adhesive strands are fixed at two points, or a large number of adhesions over the entire surface of the peritoneal sheath.
The acute form
Pathology often manifests itself in an acute form, arising suddenly with pronounced symptoms, such as:
- acute increasing pain in the abdomen;
- intestinal obstruction;
- active peristalsis of the intestine;
- febrile temperature;
The growth of intestinal obstruction, the symptoms are worse:
- there could be swelling of the colon;
- stops peristalsis;
- reduced urine output;
- occurs hypotension;
- it is a violation of the exchange of fluid and minerals;
- deteriorating General condition, there is a weakness, weakening of reflexes;
- occurs severe intoxication.
The symptoms are less pronounced, occur periodically:
- the pain of different intensity;
- indigestion, constipation, diarrhea.
The chronic form
Adhesions in the chronic form hidden flows, can prove himself a rare drawing pains in the abdomen, digestive disorders, unreasonable weight loss. Adhesions are often the underlying cause of female infertility.
Diagnosis of adhesive disease
To assume the existence of adhesions, if the patient previously undergone surgery on the abdomen or pelvis, infectious and inflammatory diseases of the genitourinary system endometriosis.
These risk factors contribute to the formation of adhesions, however, are not an absolute guarantee of their availability. To confirm the diagnosis, you must conduct some research.
- Certain diagnostic data gives the gynecological chair.
- X-ray examination of the uterus with the introduction of contrast medium determines the obstruction of the fallopian tubes, which are often adhesions. However, if the patency of the infundibulum, adhesions not to exclude.
- The results of the ultrasound cannot determine the presence of adhesions in the abdominal cavity.
- High accuracy of the results is provided by magnetic resonance imaging.
The main method of diagnosis of adhesive disease remains laparoscopy. With the help of special instruments introduced into the abdominal cavity of a patient during a laparoscopy, the doctor can assess the degree of development of the pathology and, if necessary, immediately produce therapeutic manipulation.
Treatment of postoperative adhesions
If adhesions are just beginning to be formed in place of the inflammatory process, the possibility of spontaneous resorption with rapid and appropriate treatment. Over time a thin film of adhesions sugrobova, condense, and become more like scars.
The main method of treatment of acute and advanced chronic forms of the disease is surgical removal of adhesions. The patient receives General anesthesia, and the surgeon using special tools detects, dissects and removes adhesions.
- For access to the abdominal cavity can be used laparotomies (abdominal incision) and laparoscopic methods (access is via punctures).
- Excision of adhesions is performed using laser, electrocautery, or water pumped under high pressure (equidistance).
The operation provides simultaneous removal of pathological formations, but does not guarantee against relapse. The more the body takes a surgery, the more likely the development of adhesions. Therefore, special methods are often used for the prevention of pathologies after curative surgery: the introduction of barrier liquids (mineral oil, dextran), wrapping the bodies bioresorbable film.
A good effect can have enzymatic therapy, including injection-splitting enzymes (lipase, ribonuclease, lidaza, streptase) and rubbing in the stomach anti-inflammatory ointments.
One of the most powerful tools is the enzyme of human saliva. It contains substances capable of dissolving tissue adhesions. A special activity of the saliva is in the morning while the person is still not eating nor drinking. It is recommended apply liberally on the scars.
In case of manual examination of the abdomen adhesions are found thickened parts. Sometimes the pressure on them causing pulling pain. Massage is intended to create in the affected area tension, strengthen abdominal tissue, increase blood circulation, to separate bodies connected by soldering.
Need to massage gently with the fingertips, during the natural position of internal organs. Not to massage immediately after surgery until the stitches have not healed yet.
Prevention of postoperative adhesions
The principal means of preventing the formation of adhesions after surgery is, oddly enough, physical activity. The patient should get out of bed and walking the next day after surgery. Any, even the slow motion contributes to natural massage of the internal organs, which prevents scarring and sticking together of the films.
As early as possible (given the condition of the patient) should begin physiotherapy for my stomach: moderate slopes, turns the body.
The combination of motor activity and of special massage can prevent postoperative adhesive disease.