Trauma to the abdominal cavity caused by C-section results in the formation of a type of internal scar tissue, called adhesions. Abdominal adhesions may remain asymptomatic or they can cause serious complications such as bowel obstruction, infertility and chronic pain. Symptoms may appear immediately or, more often, months or years after a C-section, making it difficult to estimate prevalence. Newer instruments and suture thread employ materials that are less likely to trigger the inflammation that produces adhesions.
Definition
Adhesions are abnormal bands or ribbons of the same fibrous connective tissue that comprises scar tissue. Only instead of cementing a wound closure, adhesions "stick" to structures within the abdomen, connecting them to themselves, adjacent organs or the abdominal wall. The main problem with adhesions is that they constrict the normal movement or capacity of the organ.
Causes
According to the National Institutes of Health, a few people are born with adhesions. The vast majority develop them after surgical procedures, such as C-sections. C-sections performed under emergency conditions or in patients with infections or other medical problems are more likely to become clinically significant.
Signs and Symptoms
In most people, adhesions cause chronic, episodic, crampy, mild abdominal or pelvic pain. Pain accompanied by vomiting, bloating, inability to pass gas and constipation suggest a bowel obstruction. Infertility after an initial C-section suggests adhesions of the fallopian tubes.
Diagnosis
Adhesions do not appear on imaging studies such as x-ray and ultrasound. Clinically significant adhesions can usually be identified indirectly by the appearance of kinking or abnormal air-fluid levels in the affected organ system, and history of C-section lends support to the diagnosis.
Complications
Partial bowel obstructions may be managed in the hospital with bowel rest and decompression by a tube inserted through the nose, followed by a low-fiber diet at discharge. Complete bowel obstructions constitute a surgical emergency and require immediate removal of the affected part of the bowel. Ectopic pregnancy due to kinks in the fallopian tube requires pregnancy termination in order to reduce the risk of maternal hemorrhage and loss of fertility due to tube rupture. Some mothers refuse the procedure, even though fetal loss is unavoidable.
Repair
People who experience recurrent partial bowel obstructions, infertility or troublesome symptoms in the absence of complications benefit from elective surgery to remove the adhesions, a procedure known as lysis of adhesions. Although surgery provides immediate relief, it also carries the risk of more adhesions in the future.
References
- "Current Diagnosis and Treatment: Obstetrics and Gynecology, 10th edition;" A.H. Decherney and L. Nathan (eds.); 2007
- National Institutes of Health: National Institute of Diabetes and Digestive and Kidney Diseases: Abdominal Adhesions
- International Adhesions Society: Adhesion FAQs
