Adhesive disease is a pathology caused by the formation of connective tissue cords in the abdominal cavity after a long inflammatory process or operation. When this occurs, adhesion and gluing of the serous membranes between themselves, the deformation of the digestive system, which leads to disruption of the function of organs, to a decrease in intestinal motility. It may constrict blood vessels, reducing the diameter of the lumen of the intestine.
The main causes of adhesions after appendicitis
There are several factors that may cause adhesions after appendicitis. Among them have special meaning:
- Surgical intervention. With laparoscopic approach, the risk of adhesions formation is somewhat lower than with laparotomy.
- Long inflammatory process. With the constant migration of immunocompetent cells into the zone of infection, connective tissue gradually grows.
- Poor operation. In the presence of a cotton ball or bandage, chronic inflammation with subsequent complications is formed in the wound.
- Coagulation of blood vessels. In the process of cauterization, the doctor can touch the adjacent tissues and damage them.
After appendectomy for catarrhal appendicitis, adhesions are rarely formed. This is the result of common or severe forms of the disease, including perforated appendicitis and peritonitis. When removing a process that has not undergone significant changes, the volume of the operation is minimal. Accordingly, adhesions are not formed.
Symptoms of adhesions after removal of appendicitis
Minor adhesions are not accompanied by any symptoms. If the disease progresses, a clinical picture is formed, including pain, loss of appetite and flatulence.
The pain affects different areas of the abdomen, can be of different intensity and nature (aching, pulling, cutting). Increases during exercise or weather changes. Against a background of decreased appetite, a person gradually or rapidly loses body weight.
Abdominal distention or flatulence bothers the patient due to the stagnation of fecal masses, changes in the bacterial environment in the intestines, the accumulation of gases as the waste products of bacteria.
To determine adhesive disease in the early stages of development is almost impossible, since the clinical picture is absent. As symptoms grow, the patient seeks medical help and undergoes a series of examinations:
- General and biochemical analysis of blood. Some changes suggest an inflammatory process: an increase in the number of leukocytes, an increase in the rate of ESR, and the presence of large amounts of C-reactive protein.
- Ultrasound. The connective tissue is poorly visualized, and gas bubbles hinder the diagnostic search. Information using ultrasound can be obtained only in the case of neglected diseases.
- Radiography with the introduction of a contrast agent. Allows you to determine the area of contractions, the structure of tissues.
- Diagnostic laparoscopy. The most informative method, it can be used to determine the exact localization of adhesions and solve the issue of re-surgical intervention.
Therapy consists of two directions: conservative and surgical. Conservative treatment involves the use of a number of medications and procedures.
At the very beginning, doctors seek to reduce the severity of pain with enemas, if it is caused by constipation and flatulence, and taking antispasmodic drugs (Drotaverine, Papaverine).
For the suppression of the inflammatory process and the further proliferation of connective tissue using NSAIDs (Ketorol, Ibuprofen, Nimesil). Administered orally or intramuscularly.
Special attention is paid to the nutrition of the patient. He needs to focus on products enriched with fiber: cereals, fresh vegetables and fruits. Complex carbohydrate stimulates peristalsis and helps to eliminate fecal masses.
Excluded from the diet:
- carbonated drinks,
- White cabbage,
- black bread,
- whole milk.
All these products increase flatulence in the intestines and the severity of abdominal pain.
From physiotherapy, paraffin applications, diathermy, mud baths and iontophoresis are preferred. Exercise and weight lifting should be temporarily excluded.
During the operation (with operative treatment), the doctors push the adhesions apart, if necrotic tissue is found, the area is removed, the intestinal patency is restored or the stoma is applied. Doctors must comply with preventive measures that reduce the risk of re-formation of connective tissue cords. These include:
- making wide cuts,
- timely removal of spilled blood and complete stopping of hemorrhage,
- elimination of drying of the layers of the abdominal wall.
At the end of all manipulations, surgeons inject enzymes, drugs that have anti-inflammatory effects.
Any pathology is easier to prevent than to cure. In order not to get to the operating table again, a person needs to observe several recommendations:
- take drugs with fibrinolytic action: Streptokinase, Fibrinolysin,
- with the permission of the doctor to start moving vertically as early as possible,
- follow the prescribed diet
- perform the specified exercise.
If a person already has adhesions, then the prevention of complications of pathologies almost completely repeats the conservative treatment of the disease itself. The patient is shown nonsteroidal anti-inflammatory medications, antispasmodics, physiotherapy, therapeutic gentle nutrition.
The gradual proliferation of connective tissue without timely diagnosis and adequate therapy can cause a number of negative consequences:
- metabolic disorders in the intestinal tract,
- infertility in women (if the process has affected the appendages),
- tissue hypoxia.
The most serious complications are necrosis due to reduced oxygen and nutrient delivery and acute intestinal obstruction.
Adhesions - a frequent complication of surgical interventions. After classical appendectomy, they rarely occur. The resulting adhesions after appendicitis surgery are small and rarely manifest clinically. Such a diagnosis is not a reason for panic. In 90% of cases, the condition can be adjusted conservatively.