Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue
Granulation tissue
Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals...

 that connect tissues not normally connected.


Adhesions form as a natural part of the body’s healing process after surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 in the same way that a scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...

 forms. The term "adhesion" is applied when the scar extends from within one tissue across to another, usually across a virtual space such as the peritoneal cavity
Peritoneal cavity
The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall...

. As part of the process, the body deposits fibrin
Fibrin is a fibrous, non-globular protein involved in the clotting of blood. It is a fibrillar protein that is polymerised to form a "mesh" that forms a hemostatic plug or clot over a wound site....

 onto injured tissues. The fibrin acts like a glue
This is a list of various types of glue. Historically, the term "glue" only referred to protein colloids prepared from animal flesh. The meaning has been extended to refer to any fluid adhesive....

 to seal the injury and builds the fledgling adhesion, said at this point to be "fibrinous." In body cavities such as the peritoneal, pericardial
Pericardial cavity
The pericardial cavity is a potential space between the parietal pericardium and visceral layer. It contains a supply of serous fluid. The serous fluid that is found in this space is known as the pericardial fluid....

 and synovial cavities, a family of fibrinolytic enzyme
Enzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...

s may act to limit the extent of the initial fibrinous adhesion, and may even dissolve it. In many cases however the production or activity of these enzymes are compromised because of injury, and the fibrinous adhesion persists. If this is allowed to happen, tissue repair cells such as macrophage
Macrophages are cells produced by the differentiation of monocytes in tissues. Human macrophages are about in diameter. Monocytes and macrophages are phagocytes. Macrophages function in both non-specific defense as well as help initiate specific defense mechanisms of vertebrate animals...

s, fibroblast
A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen, the structural framework for animal tissues, and plays a critical role in wound healing...

s and blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

 cells, penetrate into the fibrinous adhesion, and lay down collagen and other matrix substances to form a permanent fibrous adhesion.

While some adhesions do not cause problems, others can prevent muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...

 and other tissues and organ
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

s from moving freely, sometimes causing organs to become twisted or pulled from their normal positions.

Adhesive capsulitis

In the case of adhesive capsulitis of the shoulder (also known as frozen shoulder), adhesions grow between the shoulder
The human shoulder is made up of three bones: the clavicle , the scapula , and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The major joint of the shoulder is the glenohumeral joint, which...

A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...

 surfaces, restricting motion.

Abdominal adhesions

Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures but may also be caused by pelvic inflammatory disease
Pelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...

. The adhesions start to form within hours after surgery and may cause internal organs to attach to the surgical site or to other organs in the abdominal cavity. Adhesion-related twisting and pulling of internal organs can result in complications such as infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...

 and chronic pelvic pain. Surgery inside the uterine cavity (e.g., suction D&C
Dilation and curettage
Dilation and curettage refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping . It is a diagnostic gynecological procedure.D&C normally is referred to a procedure involving a curette, also called sharp...

, myomectomy
Myomectomy, sometimes also fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.-Indications:...

, endometrial ablation
Endometrial ablation
Endometrial ablation is a medical procedure that is used to remove or destroy the endometrial lining of a uterus. This technique is most often employed for people who suffer from excessive or prolonged bleeding during their menstrual cycle but cannot or do not wish to undergo a hysterectomy. ...

) can result in Asherman's Syndrome
Asherman's syndrome
Asherman's syndrome , also called "uterine synechiae" or intrauterine adhesions , presents a condition characterized by the presence of adhesions and/or fibrosis within the uterine cavity due to scars...

 (also known as intrauterine adhesions), a cause of infertility.

Small bowel obstruction
Bowel obstruction
Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency...

 (SBO) is another significant consequence of post-surgical adhesions. A SBO may be caused when an adhesion pulls or kinks the small intestine and prevents the flow of content through the digestive tract. It can occur 20 years or more after the initial surgical procedure, if a previously benign adhesion allows the small bowel to spontaneously twist around itself and obstruct. SBO is an emergent, possibly fatal condition without immediate medical attention. According to statistics provided by the National Hospital Discharge Survey approximately 2,000 people die every year in the USA from obstruction due to adhesions. Depending on the severity of the obstruction, a partial obstruction may relieve itself with conservative medical intervention. However, many obstructive events require surgery to lyse
Lyse may refer to:* Lyse Abbey, a former Cistercian abbey in Pakistan* Lyse, an alternative name of Lysebotn, Norway* Lyse Energi, a Norwegian power company* Łyse, Masovian Voivodeship, a village in east-central Poland...

 the offending adhesion(s) or resect
Resection may refer to:*Segmental resection , the partial removal of an organ or other body structure*Resection , a means of establishing a location...

 the affected small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...


Association with surgery

A study in Digestive Surgery showed that more than 90% of patients develop adhesions following open abdominal surgery
Abdominal surgery
The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. Surgery of each abdominal organ is dealt with separately in connection with the description of that organ Diseases affecting the abdominal cavity are dealt with generally under their own names The term...

 and 55%–100% of women develop adhesions following pelvic surgery. Adhesions from prior abdominal or pelvic surgery can obscure visibility and access at subsequent abdominal or pelvic surgery. In a very large study (29,790 participants) published in British medical journal The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...

, 35% of patients who underwent open abdominal or pelvic surgery were readmitted to the hospital an average of two times after their surgery due to adhesion-related or adhesion-suspected complications. Over 22% of all readmissions occurred in the first year after the initial surgery. Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures.

Before the availability of adhesion barrier
Adhesion barrier
An adhesion barrier is a medical implant that can be used to reduce abnormal internal scarring following surgery by separating the internal tissues and organs while they heal....

s, adhesions were documented to be an almost unavoidable consequence of abdominal and pelvic surgery, and occurred in as much as 93% of all patients undergoing abdominal surgery.


Types of adhesions:
  1. Fibrinous adhesions. These are causes of early postoperative obstruction which settles down within 3–5 days. The majority of fibrinous adhesions will disappear in due course of time.
  2. Fibrous adhesions. If the infection is continuous or if foreign is present, the fibrinous material is converted into fibrous material.

Nonsurgical treatment for adhesions

A manual manipulative physical therapy (The Wurn Technique
The Wurn Technique
The Wurn Technique is a manual manipulation of internal adhesions that form in the body as a response to infection, inflammation, trauma or surgical intervention 1, 2. Subsequent further surgery may thus be avoided. The Wurn Technique has been cited in peer-reviewed medical journals for its...

) applied to the body's soft tissues has been examined as a nonsurgical treatment to decrease adhesions causing pain, infertility, or dysfunction. In a 2004 peer-reviewed study on the rate of natural pregnancy within one year for infertile women who received the Wurn Technique (average infertility five years), 71% [10/14] became pregnant. In a second peer-reviewed study in 2004, the therapy improved pregnancy rates for women undergoing in vitro fertilization (IVF) procedures. Women who received the therapy within 15 months before an IVF transfer had a 67% pregnancy rate vs. the 41% US Center for Disease Control national average for IVF. All study participants had histories indicating abdominopelvic adhesion formation.

American Congress of Obstetricians and Gynecologists
The American Congress of Obstetricians and Gynecologists , formerly the American College of Obstetricians and Gynecologists, is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 55,000 and represents 90 percent...

 board certified gynecologist and study co-author, Richard King, MD, says that the therapy is appropriate for women with confirmed or suspected abdominopelvic adhesions. Prior surgery, infection, inflammation, or trauma in this area [abdomen or pelvis] are all reasons for suspicion of adhesions.

External links

See Also

Active Release Technique
Active Release Technique
Active Release Technique is a soft tissue system/movement-based massage technique developed and patented by P. Michael Leahy, DC, CCSP...

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