Pelvic Adhesions

Posted by e-Medical PPT
Pelvic adhesions are considered to be post-inflammatory scar tissues that are formed after abdominal surgery, endometriosis and intra-abdominal infections. Adhesions may also be a severe and sometimes life-threatening complication. Although no universal nomenclature exists, they can be described as dense or flimsy, thick or  thin, opaque or trasluscent and vascular or avascular.

Epidemiology
3.5% of laparotomies is for adhesive intestinal obstruction.
0.9% of all admissions.
SCAR group - 1 in 3 post laparotomy pts are readmitted over 10 yrs.
 Mostly due to surgeries on ovaries and fallopian tubes in gynae and colon & rectum in gen surgery.

Pathophysiology.
Abnormal connective tissue attachments between tissues and organs( Internal scars).
Congenital or Acquired.
Trauma to the peritoneum-
                 Surgical or inflammatory.
                 Ischaemia.
                 Dessication or overheating.
                 Irritation from foreign materials.
                 Wound healing.

Risk Factors
Intrabdominal Infections: Pelviperitonitis.
                          Inflammatory pelvic disease.
                          Acute appendicitis.
                          Perihepatitis.
                          Others.
Abdominal Surgery.
Peritoneal Endometriosis.
Intraperitoneal tissue ischemia:
    Cauterization, Ligatures.
    Devascularization.
    Dryness of the serosa.

Some diagnostic considerations
Only a small percentage of patients with chronic pelvic pain have laparoscopically documented adhesions.
27% of patients without any remarkable history of adhesions present on laparoscopy.
Aproximately 50% of patients with 2 or more factors in their history really have adhesions.
An abnormal pelvic examination is useful in predicting the presence of adhesions in 74% of the cases.

Laparoscopic classification of pelvic adhesions
Stage I: Present around the fallopian tube, ovary or other area, but without impeding ovum capture.
 Stage II:  Present between the fallopian tube and the ovary or between these structures and other areas and may impede ovum capture.
Stage III:  Torsion or oclusion of the fallopian tube or complete blockage of ovum capture

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