Adhesions, the Silent Growths
by Jennifer Lewis
One of the complications of multiple surgeries for endometriosis is the
formation of scar bands or adhesions. These are not endometrial growths, but scar tissue due to the removal of
old endometrial growths during surgery. Adhesions can also form around incision sites inside the abdomen. The "bands"
can often bind pelvic organs, block tubes preventing pregnancy and can also block or "suffocate" the
bowel causing a bowel obstruction.
Adhesions in and of themselves are also painful, so it is very difficult
for a woman who has had multiple surgeries for endometriosis to determine if her ain is from recurrent endometriosis
or adhesions. This is problematic as treatment for adhesions are surgical, thus, risking the formation of further
scar bands. if this sounds like a viscous cycle you're right. Adhesions can form within hours after surgery.
I had seven laparoscopies and a total hysterectomy with removal of my
tubes and ovaries. Six months after my hysterectomy I awoke with a severe stomach
ache. The pain was about three
to five inches above my navel and it felt like someone was trying to tie a knot inside of me. After an abdominal
series of X-rays, it was confirmed that I had a bowel obstruction due to an adhesional blockage. Essentially, scar
bands had wrapped themselves around my small bowel creating a blockage. I was told that after a trial of decompression
treatment, if no better, I would need major abdominal surgery. After four days of decompression via a nasal gastric
tube (a tube that is inserted through your nose into your stomach) I was deemed no better and rushed to the OR.
This laparotomy was extensive. The incision was from my public line all the way up, 3 inches above my navel. Ouch.
The surgeon had to clip the scar bands that were suffocating my bowel causing the blockage. I was lucky. I needed
no colostomy and no resection. In some cases, a temporary colostomy may be needed after resection of the bowel
to let the bowel heal properly. A resection is where the surgeon actually removes a part of the bowel and then
reattaches the healthy segments.
I was devastated. I knew that this surgery had left behind even more
adhesions. It was not any one's fault, just a possible side effect of surgery. When the surgeon opened me up they
found massive adhesions all over my bowel and right abdominal wall. Part of my bowel had slid down to where my
uterus once was. I was told there was no way they could safely remove any further adhesions, and that they did
excise endometriosis on my abdominal wall, using Surgiceed afterwards.
Surgiceed, and other barrier methods work
to form a wall or barrier between the surgical area and the scar tissue. The intent is to help create less friction
and cohesion. Thus, fewer adhesions.
The most common sites for adhesions are the pelvic organs, most often
adhering to the bowels, uterus, tubes and ovaries. They can also form over endometrial implants themselves. Having
adhesions on or around the bowel can mimic several other intestinal disorders. It is imperative that you seek medical
help immediately if you have any of the following:
- Sharp, stabbing or strangulating pain in the center of your abdomen.
- Projectile vomiting that appears green ( from your gall bladder ) or
brown, accompanied by a foul stench.
- Absence of gas; a bloated feeling with the above symptoms.
Any of these symptoms should be checked out by a physician to rule out
intestinal obstruction.
So what can be done about adhesions? There are newer techniques used
during surgery to prevent formation, as well as speculation as to why they occur so rapidly. One method is insertion
of a degradable substance that gets absorbed by the body within a few weeks post-op. As mentioned above, it acts
as a barrier to prevent the scar tissue and surgical site from rubbing together. Prior to surgery discuss adhesions
and ways to help prevent them with your physician.
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