Women with
endometriosis describe the pain associated with adhesions
as "stabbing, sharp, pulling, sickening, intense
and nauseating" whereas adjectives most commonly
used to describe active endometriosis pain itself
are "burning, pinching, dull, heavy, and miserable"
[1].
Adhesions
are bands of fibrous scar tissue, which forms inside
the body. They can be found anywhere in the body between
almost all organs and tissue. For women with endometriosis,
they may bind an ovary to the side of the pelvic wall,
or they may extend between the bladder and the uterus,
etc.
Whilst adhesions
are more often than not spoken of as a postoperative
complication then this does not necessarily hold entirely
true for women with endometriosis, eventhough they,
of course, are a group of people who often have had
numerous surgeries and thereby, by that factor alone,
increase their risk of developing further adhesions
[2].
Endometriosis,
however, can cause local inflammation, which is a
key factor in adhesion formation. Adhesions may therefore
form as a result of endometrial implants bleeding
onto the area around them, causing inflammation, which
again leads to the formation of scar tissue as - ironically
- part of the healing process. Unfortunately, sometimes
this injured tissue does not just form a scar it comes
into contact with another inflamed area nearby and
forms a band of scar tissue - an adhesion - between
these two areas. Adhesions vary in appearances from
thin, flimy and transparent to thick, dense, and opaque.
In some cases, adhesions have been found to such a
extent throughout the pelvis to create what is known
as a "frozen" or "fixed" pelvis.
Just like
endometriosis itself, adhesions can cause pain and
subsequently affect a woman's quality of life to the
extent that her day-to-day activities are impaired
[3,4].
Yet, whilst
the problem of adhesions in endometrisis is widely
recognised, there is at the moment no way of preventing
them, when caused by the disease alone, nor a fool
proof profylactic which can be applied during surgery,
though many companies are at present working on finding
a product which prevents adhesions.
The field
of adhesions, and their prevention, remains controversial,
as these discussions prove:
The
impact of adhesions on endometriosis
Dr Robert Franklin, USA, and Professor Hugo Verhoeven,
Germany
CO2
pneumoperitoneum problems with laparoscopy
Roger Molinas PhD, Belgium, and Dr Daniel Kruschinksky,
Germany
REFERENCES
1. Zimlicki P, Ballweg ML. Adhesions and
endometriosis: the puzzle continues. In: Ballweg ML,
ed. The Endometriosis Sourcebook. Chicago:
Contemporary Books Inc, 1995:146.
2. Hummelshoj L. Endometriosis: a special problem
with adhesions. Adhesions News and Views
2002;1:25-26.
3. Duffy DM, diZerega GS. Adhesion controversies:
pelvic pain as a cause of adhesions, crystalloids
in preventing them. J Reprod Med 1996;41(1):19-26
4. Steege JF. Clinical significance of adhesions in
patients with chronic pelvic pain. In: diZerega GS,
ed. Peritoneal Surgery. New York: Springer
Verlag, 2000:343-348.
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