DefinitionAdhesions 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 NamesPelvic adhesion; Intraperitoneal adhesion; Intrauterine adhesion
Causes, incidence, and risk factorsInflammation (swelling), surgery, or injury can cause adhesions to form almost anywhere in the body, including:In joints such as the shoulderIn the eyesInside the abdomen or pelvisOnce 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)CancerEndometriosisInfections in the abdomen and pelvisRadiation treatmentAdhesions around the joints may happen:After surgery or traumaWith certain types of arthritisWith overuse of a joint or tendon
SymptomsAdhesions 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 bellyConstipationNausea and vomitingNo longer being able to pass gasPain in the belly that is severe and crampyAdhesions in the pelvis may cause chronic or long-term pelvic pain.
Signs and testsMost 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 uterusLaparoscopy looks inside the abdomen and pelvis
TreatmentSurgery 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.
ComplicationsDepending 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 providerCall your health care provider if you have:Abdominal painAn inability to pass gasNausea and vomiting that do not go awayPain in the belly that is severe and crampy
ReferencesMunireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. Surg Clin N Am. 2010;90:1227–1236Kulaylat 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.