adhesionen

Adhesionen (adhesions) are abnormal fibrous bands that form between tissues and organs, most often within the abdominal cavity after surgery or local inflammation. They can connect loops of bowel to each other or to the abdominal wall, and may also arise in the pelvis, chest, or other sites. Many adhesions cause no symptoms, but they can lead to pain, restricted movement of organs, obstruction of the intestines, or infertility depending on location.

The formation of adhesions is driven by the body's healing response. Inflammation promotes the deposition of fibrin between surfaces; normally fibrin is dissolved by fibrinolysis, but when this balance is disrupted, fibroblasts lay down collagen and scar tissue. Risk factors include abdominal or pelvic surgery, infections such as peritonitis, endometriosis, inflammatory bowel disease, ischemia, radiation, and trauma.

Clinical presentation varies. Symptomatic adhesions may cause chronic abdominal or pelvic pain, and in the bowel, they can lead to partial or complete small-bowel obstruction with pain, vomiting, distension, and inability to pass stool or gas. Pelvic adhesions can contribute to infertility or dyspareunia. Some adhesions are discovered incidentally during imaging or surgical procedures.

Diagnosis can be challenging. Imaging like CT or MRI may reveal signs of obstruction or restricted organ movement, but laparoscopy is the definitive method to identify and often treat adhesions.

Treatment focuses on symptoms. Asymptomatic adhesions usually require no intervention. Symptomatic cases may be managed conservatively or require adhesiolysis, a surgical procedure to cut the bands, though recurrence is common. Prevention emphasizes careful surgical technique to minimize tissue trauma, maintain moist surfaces, control infection, and, when appropriate, the use of adhesion barriers.