The peritoneal adhesions
The peritoneal adhesions: what do we talk about?
The peritoneal adhesions (or postoperative) are the most frequent complication of abdominal surgery and gynecological above. These fibrous cords called "flanges" by surgeons, formed from the peritoneum, three to five days after surgery. Their appearance is unpredictably anywhere in the abdomen. Forming an unexpected obstacle by nature, these adhesions can interfere or strangle unexpectedly viscera, mainly the small intestine. All patients must be made aware of their possible occurrence.
What are the risks and health issues of peritoneal adhesions?
Approximately 40% of occlusions and 70% of small bowel obstruction due to peritoneal adhesions. Occlusion neglected puts lives at risk due to lack of medical and surgical intervention fast. You might die.
In addition to the risk of bowel obstruction, adhesions complicate the work of the surgeon when necessary reintervene in these patients.
Less dangerous but very painful adhesions causing genes and chronic abdominal pain, especially during intercourse. Especially, the adhesions are the second leading cause of acquired sterility female infertility (39%), not easy to deal with and their surgical treatment (adhesiolysis) does a pregnancy rate of 45% in two years.
And nobody is immune, since current data to conclude more than 90% of adhesions after abdominal surgery. Fortunately, the presence of adhesions is not synonymous with inevitable complications! Indeed, the risk varies according to the importance of surgery: 51% for minor surgery, 72% after major surgery, 93% after multiple interventions.
The peritoneal adhesions are a real health problem, estimated that 3.3% of all surgical procedures.
What are the mechanisms of peritoneal adhesions?
Aggression of the peritoneum (the membrane that covers the abdominal viscera) causes a local inflammatory reaction that begins the healing process: the case during surgery, infection, trauma, penetrating a surgical wound. When this reaction exceeds the measurement, the cells multiply and form tangles flanges wherever inflammation is excessive.
The risk of occlusive complications of flanges is important in two years after peritoneal aggression. Some authors (Ellis) establish a persistent risk of 20% ten years after surgery.
There is a genetic predisposition to adhesions, but in general, it operates more patients, the more flanges causes therefore complications (obstruction, pain, female infertility) we find ourselves caught up in a vicious circle of operations causing flanges causing operations, etc..
How the peritoneal adhesions occur?
By unexplained abdominal pain, impromptu, when the bowel abuts the flange or binds. The intestine is very mobile, it escapes most. Sometimes it is "trapped" and chokes. The pain does not give with the passing hours, it even increases with worsening discomfort. Nausea and vomiting concurrent total interruption of gas (and stool after longer) sign occlusion, which is a surgical emergency.
Always think of adhesions to unexplained infertility from other causes: blocked tubes, endometriosis, ovarian disease, genital anatomical abnormality ... Pelvic surgical history here are very evocative: caesarean section, appendectomy ...
With what should we not confuse peritoneal adhesions?
Bowel obstruction before brutal, we must think of a peritoneal flange.
A beginner peritonitis may mislead a time. But it also requires urgent hospitalization. Restore the doctors diagnosis.
However capricious abdominal pain, pain during intercourse, are too often treated as functional disorders without organic cause and therefore treated casually. A specialist consultation will raise the doubt.
Y does it possible prevention of peritoneal adhesions?
Yes. It follows logically that has to be explained.
First, it is necessary to minimize abdominal surgery and infections. Fibroscopies also limit what is necessary, since the risk of visceral wound during the examination is not zero.
Then the visceral surgeons have established good surgical practices to reduce aggression peritoneal related to their materials and techniques. There are also medical devices placed in the abdomen at the time of the intervention, which significantly reduce the risk of flange, in accordance with their instructions.
When to consult?
Also in emergency avoidance of doubt, and before the establishment of a possible fatal occlusion.
What is the doctor?
It takes into account a surgical emergency, the primary intestinal obstruction. Then began a thorough investigation and clinical history.
Faced with persistent erratic pains, after an initial assessment with eliminated other explanations, it can go up exploratory laparoscopy measuring the risk of adhesions post-laparoscopic surgeon with.
Collaboration gynecologist is essential for women.
There are also medications (specifically called "medical devices") to be placed in the abdomen during surgery. They significantly reduce the risk of flange, subject to respect their instructions as they are not without risk: they can impede or slow healing.
How to prepare for the consultation with the doctor?
In summing up the personal history, medical documents to support: report all surgeries, infections, trauma, etc..
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