Pathogenesis of Intra-abdominal and Pelvic Adhesion Development

Anthony N. Imudia; Sanjeev Kumar; Ghassan M. Saed; Michael P. Diamond

doi:10.1055/s-0028-1082387

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med 2008; 26(4): 289-297
DOI: 10.1055/s-0028-1082387

Pathogenesis of Intra-abdominal and Pelvic Adhesion Development

Anthony N. Imudia¹ , Sanjeev Kumar¹ , Ghassan M. Saed² , Michael P. Diamond¹ ^, ²

¹Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
²C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, Michigan

Abstract

ABSTRACT

Abdominal and pelvic adhesions are a frequent occurrence and are responsible for significant morbidity resulting in abdominal and pelvic pain, infertility, and small bowel obstruction. The process of adhesion development begins when damage to peritoneal surfaces from any source (operative trauma, infection, foreign bodies, desiccation, irradiation, allergic reaction, or chemical injury) induces a series of biochemical/molecular biologic cascades involving different elements. These elements include peritoneal fluid, neutrophils, leukocytes, macrophages, cytokines, mesothelial cells, and tissue and coagulation factors, which teleologically have the intention of peritoneal repair; however, these processes also result in adhesion development. Major pathways that play significant roles in the healing process of peritoneal damage leading to adhesion development are the fibrinolytic system, extracellular matrix deposition, growth factor and cytokines, cell adhesion molecules, angiogenesis, apoptosis and proliferation, and remesothelialization. Greater understanding of the regulation and interaction of these processes provides the potential for reduction of postoperative adhesion development.

KEYWORDS

Postoperative adhesions - intra-abdominal - pelvic - development - pathogenesis - de novo adhesion formation - adhesion re-formation

Full Text

References

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Michael P DiamondM.D.

Wayne State University–Detroit Medical Center

3750 Woodward Avenue, Suite 200-D, Detroit, MI 48201

Email: mdiamond@med.wayne.edu