Adhesions

Generality

Adhesions are bands of fibrous-scar tissue, which abnormally unite normally separate parts of the same organ or distinct organs or tissues, between which there is direct contact.

Intestinal adhesions as a possible cause of intestinal obstruction: these are bundles of fibrous tissue (internal scars) that form as a result of trauma, inflammatory processes or surgery

Adhesions can form anywhere; however, they have a predilection for the organs of the abdomen (abdominal adhesions), the organs of the pelvis (pelvic adhesions) and the heart (cardiac adhesions or pericardial adhesions).
The formation of adhesions is a consequence of the body's repair mechanisms, which arise from tissue injuries due, for example, to surgery, infection, severe blunt trauma, severe inflammation or exposure to ionizing radiation.

What are adhesions?

Adhesions are bands of fibrous-scar tissue, which abnormally join normally disjoint parts of the same organ or distinct organs or tissues, between which there is a relationship of extreme proximity or even mutual contact.
Any part of the body can be subject to adhesions; however, the abdominal organs and tissues (ie the abdomen), the pelvic organs and tissues (ie the pelvis) and the heart are more predisposed to the problem.

Causes

The development of adhesions is a consequence of the body's repair mechanisms, set in motion by the insults or tissue injuries that can take place after surgery, a particular infection, severe blunt trauma, an inflammatory state or exposure to ionizing radiation harmful.
The possibility of adhesions forming depends on the "inability of the cells responsible for the aforementioned repair mechanisms to distinguish the different portions of the same organ or two different anatomical structures, if there is a continuity between these".

In other words, the formation of adhesions is the result of reparative processes which, by nature, are not very precise: the reparative cells know where to act and when to act, but they do not know how to recognize the various portions of an organ or two distinct organs / tissues, therefore they operate indiscriminately.

Types

There are various types of adhesions. The criterion of distinction for the various types is, as can be guessed, the location of the organs or tissues involved.
The most common types of adhesions include: abdominal adhesions, pelvic adhesions and cardiac adhesions.
On the other hand, the less common types of adhesions include: peridural adhesions, peritendinous adhesions and adhesions to the shoulder capsule (also known as adhesive capsulitis of the shoulder or frozen shoulder).

ABDOMINAL ADHERENCES

The adhesions affecting the internal organs or tissues of the abdomen are called abdominal adhesions.
If conspicuous, the presence of abdominal adhesions alters not only the normal anatomy of the organs / tissues involved, but also their functionality.
The most common site of abdominal adhesions is the intestine.
This organ lends itself to the formation of adhesions due to its particular anatomy: it is a very long cylindrical structure, with numerous folds on itself and different points of contact, which concern portions that are also very distant from each other.
Other sites of significant abdominal adhesions are the liver and gallbladder.
In about 90% of cases, the presence of abdominal adhesions is due to a previous abdominal surgery; in the remaining 10% of the circumstances, however, it may depend on one of the following conditions:

• Severe appendicitis;
• Ulcerative colitis;
• Severe infectious gastroenteritis;
• Congenital tissue anomaly;
• A sexually transmitted disease, such as gonorrhea, chlamydia etc.

Abdominal adhesions tend to be asymptomatic (i.e., symptom-free).
However, if their presence is conspicuous and affects particularly sensitive organs or tissues, they can cause a painful sensation in the abdomen and, in extreme cases, give rise to a series of complications.
As a rule, exploratory laparoscopy is essential to make a correct and reliable diagnosis of abdominal adhesions; exploratory laparoscopy is a minimally invasive surgical technique, which allows to view the inside of the abdominal-pelvic cavity using a small number of small skin incisions.
The current treatment of abdominal adhesions consists of a surgical intervention aimed at removing the bands of fibrous-scar tissue. Generally reserved only for symptomatic cases, and symptomatic cases with complications, the aforementioned surgery is called adhesiolysis.
Today, surgeons can count on two surgical techniques to perform an "adhesiolysis: therapeutic laparoscopy and laparotomy."
Adhesiolysis is effective, but it could prove to be a double-edged sword, since, being an abdominal surgery operation, it can lead to the onset of new abdominal adhesions.