• During the body's reaction that leads to an adhesion, chemicals called inflammatory mediators and histamines are released from the blood (more specifically the blood's mast cells and leukocytes).
• Capillaries dilate. This allows leukocytes, red blood cells and platelets to concentrate at the injury site in a bundle called a fibrinous exudate.
• A variety of other factors are at play in the system such as as prostaglandins, bradykinin, chemotactic agents, lymphokines, seretonin and transforming growth factor.
• At this point in time fibrinolysis may clear the fibrinousexudate.
• In order for this to occur, plasminogen must be converted to plasmin by tissue plasminogen activator (t-PA). There is constant interplay between the t-PA and plasminogen-activator inhibitors.
• Unfortunately surgical trauma normally decreases t-PA activity while simultaneously increasing plasminogen activator inhibitors.
• If this occurs, the fibrinous exudate is transformed into an organized adhesion where fibers of collagen are deposited.
• Blood vessels begin to form, which leads to an adhesion.

• Adhesive Disease accounts for 49-74% of small bowel obstructions.
• Adhesive Disease accounts for 15-20% of infertility cases.
• Adhesive Disease accounts for 20-50% of chronic pelvic pain cases.
• Reduced quality of life.
• Loss of work days and productivity
• Increased risk, complexity and complications during subsequent surgery.
• One study showed a 19% rate of adhesion-related bowel perforation during subsequent/secondary operations.
• Bowel perforations occur even more frequently (33%) during surgery for SBO.
• Patients with adhesion-related perforations had significantly higher postoperative complications (leaks, wound infections, hemorrhages and length of stay).

The Impact of Adhesions on Surgeons:

• Increased reoperative times
• Increased risk of enterotomy
• Increased level of surgical complexity

• Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder, and usually occur after surgery.
  Adhesions between anterior uterine wall

  Adhesions between uterus ,adnexa and bowel posteriorly

• Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions within the fallopian tubes.
• A woman's eggs pass through her fallopian tubes into her uterus for reproduction.
• Tubal adhesions can lead to infertility and increased incidence of ectopic pregnancy in which a fetus develops in the tube.

Abdominal adhesions:

• Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery.
• Abdominal adhesions also occur in 10.4% of people who have never had surgery.
• Most adhesions are painless and do not cause complications.
• However, adhesions cause 60%-70% of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.
  Bowel adhesions

  

• Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years.
• As scar tissue begins to restrict motion of the small intestines, passing food through the digestive system becomes progressively more difficult.
• The bowel may become blocked.
• In extreme cases, adhesions may form fibrous bands around a segment of an intestine. This constricts blood flow and leads to tissue death.

De novo adhesions

• De novo are new adhesions that may form at a site of direct surgical trauma such as an incision.
• They may also develop at locations away from the site of surgery, for example, around the adnexa at the time of a cesarean section.
• Adhesions may also reform following adhesiolysis or adhesiectomy.
  

Three broad types of adhesions exist, but the underlying pathophysiology is similar for each:

• Filmsy
• Vascular
• Cohesive

• colectomy,
• hernia repair
• adhesiolysis for bowel obstruction.
• Appendectomy
• Cholecystectomy
• Cancer surgery
• Liver and spleen surgery

Adhesions have been documented to occur in up to 94% of patients after major abdominal surgery

• Chronic pain
• Infertility
• Bowel obstruction
• Gastro-esophageal reflux disease, (GERD)
• Urinary Bladder dysfunction
• Pain and difficulty having a bowel movement
• Pain on movement such as: Walking, sitting or laying in certain positions.
• Loss of Nutrients due to poor eating habits or loss of appetite.
• Loss of employment due to lost work days
• Loss of family and social life
• Emotional Disorders such as: Depression, Thoughts of Suicide, Hopelessness

Other intestinal problems can accompany the pain. Constipation or obstruction is sometimes encountered. Alternating constipation with diarrhea from partial obstruction can also be seen. Symptoms may also be related to the gynecologic orders in women as this disorder frequently affects women. Changes in the menstrual cycle, infertility, and pain with sexual intercourse can be encountered. Other symptoms, not directly related to the adhesions, can also be encountered. Since ARD generally results in chronic problems, anxiety and depression can result. Strained relationships can occur especially when the disorder affects sexual function. Difficulty with conception can result. This further adds to the anxiety and problems with self esteem experienced by women who suffer with this disorder. Difficulty eating can result in poor nutrition, weakening suffers overall medical condition and can also lead to a decrease in immune function leading to many other illnesses. Since many of the symptoms related to ARD are vague and wide spread and often include emotional factors, they are often difficult to diagnose. Symptoms of ARD will often be attributed to other abnormalities. Patient will often carry multiple diagnoses including chronic fatigue syndrome, endometriosis, irritable bowel syndrome, fibromyalgia, depression, anxiety, along with a whole host of other possible syndromes. While multiple disorders can certainly exist in one patient, the confusion over which abnormality is truly causing the symptoms adds to the frustration of ARD. This, unfortunately, adds to the discomfort experienced by those who suffer with adhesions. Undiagnosed chronic pain causes so much physical and emotional pain for victims of adhesion related disorder – and fills their lives with so much indecision. In time the effects of ARD will begin to affect the lives of their families, their relationships and their jobs. This inordinate control by ARD has the power to erode and change our lives – and not necessarily for the better! It is so important to believe in yourself, trust the feelings you have about your pain, and tell it like it is. You have the right to be listened to and treated with respect – nothing less!!

• pain
• cramps
• intermittent vomiting
• difficulty with passing gas or having a bowel movement
• swelling of the abdomen

Symptoms vary depending on the tissues involved. For example, in the gastrointestinal tract, bowel obstructions may occur.

Mechanical small bowel obstruction after previous surgery can be the most severe effect of adhesions. In the uterus and in the pelvis, adhesions can cause infertility and other reproductive problems. The adhesions can block the ends of the fallopian tubes causing infertility.

Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly. As a result, people experience many complaints based on where an adhesion forms and what it may disrupt. Typically, adhesions show no symptoms and go undiagnosed. These adhesions cause no problems at that moment , but they can obstruct the intestine in about 2 percent of all patients. These obstructions can occur several years later. Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.

• Adhesions above the liver may cause pain with deep breathing.
• Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
• Adhesions involving the vagina or uterus may cause pain during intercourse.
• It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
• Small bowel obstruction (intestinal blockage) due to adhesions is a surgical emergency.
  • These adhesions trigger waves of cramplike pain in your stomach. This pain, which can last seconds to minutes, often worsens if you eat food, which increases activity of the intestines.
  • Once the pain starts, you may vomit. This often relieves the pain.
  • Your stomach may become tender and progressively bloated.
  • You may hear high-pitched tinkling bowel sounds over your stomach, accompanied by increased gas and loose stools.
  • Fever is usually minimal.
• Such intestinal blockage can correct itself.

However, you must see your doctor. If the blockage progresses, these conditions may develop:

• Your bowel stretches further.
• Pain becomes constant and severe.
• Bowel sounds disappear.
• Gas and bowel movements stop.
• Your belly will grow.
• Fever may increase.
• Further progression can tear your intestinal wall and contaminate your abdominal cavity with bowel contents

Intra-abdominal adhesions are usually the result of surgical or gynecologic operations, pelvic inflammatory disease (gonococcal or chlamydial), appendicitis or endometriosis. Adhesions may be responsible for chronic persistent abdominal pain without associated pelvic pathology. Though adhesions probably cause pain by entrapment of expansile viscera, the relationship of adhesions to abdominal pain is still controversial. In contrast, mechanical small bowel obstruction after previous surgery demonstrates unequivocally the most severe effect of adhesions. Patients with chronic or recurrent abdominal pain and a history of numerous abdominal surgical procedures are often denied treatment if they are not obstructed or symptomatic of intermittent bowel obstruction.