ADHESIONS: THE SILENT GROWTHS

One of the complications of multiple surgeries for endometriosis is the formation of scar tissue or adhesions. These are not endometrial growths, but scar bands created due to the removal of endometrial tissue during surgery or surgery itself. Adhesions can also form around incision sites within the abdomen. These "Bands" can often bind pelvic organs, block tubes and ovaries preventing pregnancy and also block or suffocate the bowel causing a bowel obstruction.

Adhesions in and of themselves are also painful without the presence of endometriosis, so it is often difficult for a woman who has had multiple surgeries or one who has adhesion with no other form of endometriosis to determine if her pain is from recent endometriosis or adhesions alone. This is problematic as treatment for adhesions are surgical, thus, risking the formation of further scar tissue. If this sounds like a viscous cycle you're right - Adhesions can form within hours after surgery!

I have had numerous laparoscopies and laparotomies including a total hysterectomy. Six months after my radical 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 determined that I had a bowel obstruction due to an adhesional blockage. Essentially, scar bands had developed and wrapped themselves around my small bowel creating a blockage. After a trial decompression treatment using a naso-gastric, or NG tube, ( a tube that is inserted into your nose and down into your stomach ) I was deemed no better and rushed into surgery. The laparotomy was extensive and the incision was from the pubic line all the way up past my navel. Ouch! The surgeon had to clip the scar bands that were suffocating the bowel and causing the blockage. I was fortunate in that I needed no colostomy bag and no resection. In some cases, a temporary colostomy may be required while the other parts of the severed bowel heal. A resection is where the surgeon actually removes a part of the bowel then reattaches it.

I was devastated. I knew that this surgery had left behind even more scar tissue and adhesions. It was not anyone's fault, just a possible side effect of both endometriosis and surgery. When the surgeon opened me up they found massive adhesions all over my bowel and intestine. Part of my bowel had slid down to where my uterus once was. I was told there was no way they could safely remove all the adhesions without creating more and that they did excise what they could. They used 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. Hence, fewer adhesions.

The most common sits for adhesions are the pelvic organs, adhesing to the bowel, 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:

1. Sharp, Stabbing or strangulating pain in the center of your abdomen.

2. Projectile vomiting that appears green ( from your gall bladder 0 or brown, accompanied by a foul stench.

3. Absence of gas and a severe bloated feeling.

Any of these symptoms should be checked out by a physician to rule our intestinal obstruction.

So what can be done? 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 operative. Newer techniques are on the horizon.

Jennifer Lewis
Author, Endometriosis: One Womans Journey Freelance writer