Adhesions are bands of scar tissue that form inside the body, causing organs or tissues to stick together. They often arise after surgery, but can also result from infections or inflammation. Diagnosing adhesions can be challenging, as they may not always present with clear symptoms and are difficult to visualize with standard imaging.
What Are Adhesions?
Adhesions are fibrous bands of scar tissue that develop between internal tissues and organs that are typically separate. Normally, organs like those in the abdomen and pelvis have smooth, slippery surfaces, allowing them to move freely. When adhesions form, they create abnormal connections, causing these surfaces to stick together. These bands can range from thin, transparent sheets to thick, dense cords.
Adhesions most commonly form in the abdomen and pelvis, affecting the intestines, female reproductive organs, and the abdominal wall. They can also appear around the heart, lungs, and joints. Their development is the body’s natural healing response to tissue injury, often stemming from surgical procedures, especially abdominal or pelvic surgeries. Other causes include infections like appendicitis or pelvic inflammatory disease, inflammation from conditions such as endometriosis, or radiation treatment.
Ultrasound and Adhesion Detection
Ultrasound imaging uses sound waves to create pictures of internal body structures. Directly visualizing adhesions with ultrasound can be challenging because they are often thin and blend with surrounding tissues. However, ultrasound can sometimes identify indirect signs suggesting their presence.
One indirect sign is restricted organ movement, known as an abnormal “visceral slide.” Normally, organs like bowel loops or the uterus slide freely against adjacent tissues during respiration or with gentle pressure from the ultrasound probe. A lack of this normal sliding motion, where organs appear stuck together or to the abdominal wall, can indicate adhesions. Ultrasound may also reveal bowel loops that are abnormally clustered or fixed, or show localized fluid accumulation near suspected adhesion sites.
Both transabdominal and transvaginal ultrasound can be used, depending on the suspected location. Transabdominal ultrasound, performed externally, can identify adhesions between the abdominal wall and internal organs. Transvaginal ultrasound, involving a probe inserted into the vagina, is useful for detecting pelvic adhesions, such as those involving the ovaries and uterus, and assessing if these organs are abnormally fixed.
Other Ways to Diagnose Adhesions
Given the limitations of ultrasound in directly visualizing adhesions, other diagnostic methods are often employed, especially when symptoms suggest their presence. Imaging techniques like Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) provide more detailed views of the abdominal and pelvic cavities. Adhesions are rarely directly visible on CT scans, but the scan can detect complications like bowel obstruction, appearing as an abrupt transition from dilated to collapsed bowel segments. CT scans may also show indirect signs such as acutely angulated bowel segments or a “matted” appearance of clustered bowel loops.
MRI can also offer insights into adhesions, especially functional cine-MRI, which assesses organ movement. While small adhesions might not be clearly visible, MRI can detect larger adhesions or those in fluid-rich areas, appearing as bright areas. The gold standard for definitively diagnosing adhesions is diagnostic laparoscopy. This minimally invasive surgical procedure involves small incisions and inserting a thin, lighted tube with a camera to directly visualize the inside of the abdomen and pelvis. Laparoscopy allows surgeons to see the exact location, extent, and nature of the adhesions, and often, to treat them during the same procedure. Diagnosis often relies on a combination of a patient’s medical history, symptoms, and findings from various imaging studies.
Recognizing Potential Adhesions
Many individuals with adhesions experience no symptoms. However, when symptoms do arise, they can range from mild discomfort to severe conditions. One common symptom is chronic pain, localized in the abdomen or pelvis. This pain often feels vague, crampy, or like a pulling sensation, and can worsen with physical activity, menstruation, or sexual intercourse. Adhesions can cause pain by restricting organ movement or pulling on nerves.
Adhesions are also a leading cause of bowel obstruction, which can be partial or complete. Symptoms include severe abdominal pain or cramping, bloating, nausea, vomiting, and an inability to pass gas or stool. A complete bowel obstruction is a medical emergency requiring immediate attention. In women, pelvic adhesions can lead to infertility by blocking fallopian tubes or interfering with the normal function of the ovaries and uterus. They can also cause pain during sexual intercourse (dyspareunia) or painful bowel movements. If these symptoms occur, especially after prior surgery or infection, consult a healthcare professional for evaluation.