Adhesive disease : pelvic adhesions - Causes, Symptoms and Treatment .MF .
adhesive disease (morbus adhaesivus) - a condition that is characterized by the formation of adhesions in the abdominal and pelvic organs - the connective tissue strands.
In recent years, the incidence of adhesive disease in gynecology greatly increased.
This is due to many factors provoking in the modern world.
causes and mechanism of occurrence of adhesions in the pelvis
The most frequent reasons for the emergence of adhesions in the pelvis following:
1) inflammatory diseases of the pelvic organs .These include infection of the uterus, appendages and pelvic peritoneum: endometritis (uterine cavity inflammation), metroendometritis (inflammation of the mucosa and muscle of the uterus), the parameter (the spread of infection to the space outside of the uterus), oophoritis (inflammation of the uterus), pelvioperitonit (inflammation of the pelvicperitoneum).
predisposing factor for the development of these infectious diseases are long wearing an intrauterine device;scraping the ut
mechanism of adhesive disease with the following: in case of inflammation in the pelvis become inflamed edematous tissue, on the peritoneum appears patina of fibrin.Fibrin glues like lying next to the tissue.As a result, there is an obstacle to the further spread of the inflammatory process.After suffering an inflammatory disease bonded fabric surface to form a seam between.Adhesions - this is the spikes, they perform a protective function - limit the inflammatory process.
If you get an infection in the fallopian tubes are not always produced the inflammatory exudate.May occur aborting an acute inflammation of the mucous membrane of the pipe to its transition to the stage of exudation.In many patients, resulting in an acute stage of the disease exudates absorbed.Only a small proportion of patients with an acute inflammation of the fallopian tubes leading to the spread of inflammatory serous or purulent exudate throughout the pipe.The fluid, poured out through the abdominal orifice tube into the abdominal cavity, can cause a reaction - loss of fibrin to seal the abdominal opening, which eventually sealed obliterans.Fallopian tubes becomes a closed cavity.With the development of purulent process it is formed piosalpinks.If the royal opening of the pipe is still open may outpouring of fluid into the uterus through the vagina and then to the outside.Because tubal exudate and by hematogenous bacteria can penetrate into the ovary and cause it to purulent fusion (piovar).
How fallopian tube and ovary on the accumulation of inflammatory exudate increased in size, and the pipe gets retortoobraznuyu and yaichnik- spherical shape.The tubes are observed mucosal epithelium desquamation portions and bonding opposing surfaces to form baffles.The result is a multi-chamber saccular education, in some cases filled with serous exudate - hydrosalpinx, in others - a purulent exudate - piosalpinks.When gluing, and then fusion of piosalpinks and piovara places adhesions may occur to melt the capsules.
tunica albuginea of the ovary and fallopian tube wall as deposits in these hyaluronic acid and proliferation of fibrous tissue are transformed into dense, opaque capsules.These inflammatory Education (hydrosalpinx, piosalpinks, piovar, suppurative tubo-ovarian tumor) is usually spliced with the pelvic wall, the uterus, fallopian tubes, ovaries opposite side, with the gland, bladder and intestines.Education-tight capsules germs and extensive adhesions in the acute stage plays a protective role in preventing the spread of infection.Later, after the death of pathogens of the inflammatory process, these impervious capsule delayed absorption of accumulated serous or purulent exudate.
Location pelvic inflammatory saccular formations varies considerably, often disturbed the function of adjacent organs (rectum, bladder) and, of course, the reproductive function.
2) inflammatory diseases of the abdominal cavity, for example, appendicitis;
3) mechanical damage to the pelvic and abdominal cavity (trauma, surgery).Adhesions develop hemorrhage into the abdominal cavity, especially when infected blood streamed.In gynecology often cause the formation of adhesions is bleeding with an ectopic pregnancy and ovarian apoplexy.Experimentally proved the value of abdominal trauma, overheating or cooling it in the development of adhesive disease.
presence of foreign bodies (wipes, drains) in the abdominal cavity during surgery is also accompanied by the formation of adhesions.;
4) bleeding in the abdomen (ectopic pregnancy, ovarian apoplexy, etc.);
5) endometriosis - a disease characterized by the growth of endometrial tissue outside of the endometrium - the inner layer of the uterus.
inflammatory process in the abdomen and pelvis does not always lead to the formation of adhesions.If treatment is started on time and correctly carried out, the probability of formation of adhesions is reduced.Adhesions are formed when an acute process becomes chronic, and the healing process is extended in time.
most common cause adhesive disease is inflammation of the appendix (appendectomy) and appendectomy (about 43%), in second place are the diseases and surgery on the pelvic organs and surgery for bowel obstruction (30%).
symptoms of the presence of adhesions in the pelvis
Severity of symptoms in adhesive disease is entirely dependent on the extent of adhesions in the pelvic area.Variants from asymptomatic to severe clinical picture.There are three main clinical forms of the disease:
1) acute.Patients with this form of the disease have a rather pronounced complaint, gradually increasing pain, worried about nausea, vomiting, fever, increased heart rate.Examination of the abdomen (pressing) causes a sharp pain.There is a bowel obstruction.After that, the patient's condition is deteriorating: the pressure drops sharply reduced the amount of urine, there is a weakness, drowsiness.Violated the water-salt and protein exchange in the body.Condition of patients with acute adhesive disease is assessed as extremely severe;
2) intermittent form: pains occur periodically, could disturb bowel disorders - constipation, diarrhea.
3) chronic form - characterized by latent clinical picture: the clinic is not available, or arise from time to time nagging abdominal pain, and constipation.It is a chronic form of adhesive disease is most common in gynecological practice.Quite often a manifestation of latent infections and endometriosis, which neither the patient nor the gynecologist do not guess.Adhesive process causes obstruction of the fallopian tubes, leading to infertility.It is with this complaint, the inability to get pregnant within a year -patsientki and turn to the gynecologist in asymptomatic chronic form of adhesive disease.
When an attack of pain and symptoms of poisoning (nausea, vomiting and fever) the patient should immediately consult a gynecologist in the consultation.If complaints are pronounced - you need to call an ambulance.Based on the symptoms, the adhesive disease can be confused with many zabolevaniyami- from acute surgical diseases (appendicitis, bowel obstruction, ectopic pregnancy), and ending with the banal poisoning.
self-medication in this case is unacceptable -only competent specialist advice to help protect yourself from unpleasant consequences.
Diagnostics adhesive disease
Diagnosis of adhesions in the pelvis is not as easy to suspect the presence of her gynecologist may, at the first examination in the presence of specific complaints and anamnesis (surgery in the past).When vaginal study of the pelvic organs are immobile or slightly mobile in the study.In marked adhesive process inspection on the chair causes pain.However, a reliable diagnosis can be made only after a series of analyzes and studies:
- Smear on the flora of the vagina;
- PCR - diagnosis - screening for reproductive tract infections;
- pelvic ultrasound;
- MRI - magnetic resonance imaging of the pelvic organs - is carried out after a preliminary pelvic ultrasound.Non-invasive imaging studies, having a high information content;
- Diagnostic laparoscopy - operational, but the most reliable method of diagnosis.Makes two small incisions in the abdominal wall.The abdominal cavity is forced air.In one section of inserting a laparoscope (a thin tube with a video camera at the end of the block, which is transmitted through the image on the screen).In another section of manipulyator- inserted with the help of the doctor examines the bodies shifts, examining in detail.This allows you to confidently make an accurate diagnosis.
Depending on laparoscopic pattern distinguish 3 stages spread adhesive disease:
1st stadiya- spikes are located just around the fallopian tube, ovary or other area, but do not prevent the capture of the egg;
2nd stage-spikes are located between the fallopian tubes and ovaries, or between these bodies and prevent the seizure of the egg;
3rd stage - torsion of the fallopian tube blockage fallopian tube adhesions, making absolutely impossible to capture the egg.
obstruction of the fallopian tubes according hysterosalpingography (in the uterus injected contrast agent produce X-ray images), gynecological examination and ultrasound with a high degree of reliability indicating the presence of adhesions, but the fallopian tubes does not exclude the presence of adhesions, seriously impede pregnancy. Conventional ultrasound will not reliably detect the presence of pelvic adhesions .
Thus, it is staging raprostraneniya adhesive process is fundamental to the definition of treatment.In many cases, the patient can be observed over the years, and examined by a gynecologist with unclear diagnosis, but that laparoscopy can not only make an accurate diagnosis, but also to simultaneously effective treatment of adhesive disease.
treatment of adhesive disease
treatment of adhesive disease entirely depends on severity of the disease, it can be both conservative and surgical.Just specify that in acute and intermittent form of the disease, surgery - laparoscopy, it is the only method of treatment due to the high efficiency and rapid effect.It is often combined with surgical treatment conservative to great effect.
In the chronic form of the disease is possible to use adhesive only conservative treatment.It is necessary to identify the cause of adhesive disease.If found any urogenital infection (such as chlamydia), the first and foremost treatment should be directed at the elimination of the underlying disease, to prevent the further spread of adhesions.To this end, the drugs of choice are antibiotics and anti-inflammatory drugs (NSAIDs, corticosteroids).If the cause of adhesive disease - endometriosis, then prescribe hormone therapy, anti-inflammatory drugs, desensitizing and symptomatic therapy.
Broad popular nonspecific therapy - fermentoterapiya - fibrinolytic drugs dissolve fibrin (Longidaza, trypsin, chymotrypsin), it is quite effective drugs, absorbable small spikes.In the absence of physical therapy used acute infectious process - internal and external laser therapy magneto-laser therapy.
This treatment is not a panacea for the chronic form of adhesive disease.Conservative treatment is most effective when the 1st stage of the disease.
With the ineffectiveness of all these methods and further distribution of adhesions is a medical diagnostic laparoscopy.Typically, the surgeon-gynecologist diagnoses adhesive disease is already on the operating table while conducting an operation - dissects and removes adhesions.Perhaps the 3 options laparoscopy:
-spayki dissected by laser - laser therapy;
-spayki dissected by means of water under pressure - akvadissektsiya;
-spayki dissected using electrocautery - electrosurgery.
choice in favor of this or that method of treatment determined by the doctor at the time of laparoscopy, depending on the location of adhesions and prevalence of process.During surgery, the surgeon carries out and conservative treatment for the prevention of adhesions: input barrier fluid - dextran povilin, etc.), on the fallopian tubes and ovaries cause absorbable polymeric film.
Factors influencing treatment
adhesive disease at diagnosis "adhesive disease" it is necessary to adhere to certain canons and rules in order to avoid repeated recurrences:
- visit the gynecologist every six months;
- rational diet - eat small portions, with short intervals between meals - about 5 times a day;Avoid foods that cause flatulence;
- physiotherapy procedures are very useful for a speedy recovery, so it is recommended to visit a physiotherapist - can be carried out electrophoresis with drugs, therapeutic massage and physical education);
- in the event of pain attack can be used antispasmodics (no-spa, papaverine) .If attacks persist, you should consult a gynecologist and not to self-medicate themselves.
After treatment - surgery or conservative treatment -patsientkam shows physical rest for 3-6 months, the dynamic monitoring of the gynecologist.In the first 2-3 months is necessary to adhere to the above rational diety.Bystromu recovery also contributes to physical therapy and physiotherapy.When all the rehabilitation measures favorable prognosis.
Folk remedies of adhesions in the pelvis
Traditional medicine is also used in adhesive disease as symptomatic treatment.However, it should be noted that all the folk remedies are effective only if it is a single spikes, otherwise herbal tinctures assistants and not from long-term "overlap" in the grass can only worsen the condition.It is helpful to use herbal infusions in the rehabilitation period and as an adjunct to the basic treatment.For this purpose, use Hypericum in particulate form and dried.A tablespoon of herb St. John's wort pour a glass of boiling water, boil for 15 minutes, strain the broth and take 1 \ 4 cup 3 times a day.
Complications adhesive disease
adhesive disease very terrible disease, to look at it through my fingers.There are cases when the disease is quite favorably proceeds, without giving itself felt, however, under unfavorable circumstances, the adhesive process is spreading rapidly in the absence of a competent approach and treatment of possible serious complications, such as infertility, menstrual irregularities, bending (offset) of the uterus,intestinal obstruction, obstruction of the fallopian tubes, ectopic pregnancy, not to mention the acute form of the disease, which can lead to very adverse consequences for life.
prevent disease include: regular monitoring by a gynecologist, gynecological massage, timely treatment of urogenital infections, natural family planning: protection from unwanted pregnancy, rejection of abortion, birth vaginally, regular sexual life.What to do?