Re: Regenerating internal adhesions

Posted By HFHSM.D.-ym on March 16, 1998 at 11:54:43:

In Reply to: Regenerating internal adhesions posted by Dorothy on March 12, 1998 at 16:27:30:









34 year old woman has had surgery for pancreatitis, gall bladder, developed peritonitis. Now has adhesions spreading in pelvis and into lungs. Looking for info on research being done on this or doctor ANYWHERE willing to do exploratory.
Dear Dorothy,
Adhesions are a serious, common and costly complication of surgery. It has been estimated that adhesive small bowel obstruction may cause as many as 2000 annual hospital admissions which may be associated with  an estimated  annual cost of about 6-13 million dollars.
Therefore, the mainstay of treatment is to prevent the development of adhesions in the first place. Since one of the proven causes of intestinal adhesions is the presence of foreign microbodies (secondary to contamination from the surgeons glove powder etc.) surgeons today try to minimize tissue contamination during operations. It has been recommended that the use of powdered gloves and the practice of suturing the peritoneum (lining covering the abdominal cavity) should be omitted from clinical practice. Another technique that is used during surgery is irrigating the abdominal cavity with various solutions to prevent adhesion formation. Saline, hyperosmolar solutions of peritoneal dialysis fluid and ionically cross-linked formulations of hyaluronic acid with trivalent iron (0.5% Ferric Hyaluronate Gel-Lubricoat; Ethicon, Inc.)
have all been used with variable results. Yet another experimental technique to prevent the formation of adhesions is to place an adhesion barrier at surgery. An example of this type of barrier is a compound called polytetrafluoroethylene. Unfortunately, the experimental studies using these various materials have only been done in animals and I am not aware of any  research in humans.
In your instance, however, we are dealing with adhesions that have already developed post-operatively. If  a blockage of the intestine is documented there would be little doubt that surgery is indicated. However,  the dilemma arises in patients who have chronic pain  or bowel habit changes. There is always a risk of forming new adhesions every time an abdominal operation is performed. I think that a good approach is to perform contrast studies of the intestine to see and document a particular area of the intestine that might be responsible for the pain. If the studies are normal I generally do not recommend an exploratory laparotomy. I hope you find this information helpful. Good luck to you.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians Office and make an appointment to see Dr. Muszkat one of our experts in Gastroenterology.

HFHSM.D.-ym
Keywords: adhesions, small bowel obstruction, exploratory laparotomy



  



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