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.
Abnormal connective tissue attachments between tissues and organs( Internal scars).
Congenital or Acquired.
Trauma to the peritoneum-
Surgical or inflammatory.
Dessication or overheating.
Irritation from foreign materials.
Intrabdominal Infections: Pelviperitonitis.
Inflammatory pelvic disease.
Intraperitoneal tissue ischemia:
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