If there are spikes what to do. Safety process in small pelvis

Spikes after the removal of the uterus are frequent complications And there are 90% of the operated women. it dangerous consequence Operational intervention, as a result, various functional disorders may arise in internal organs, Up to the symptoms of intestinal obstruction.

What is spikes

Extensive spikes of internal organs doctors are also called adhesive disease. However, it is important to distinguish the physiological process of the formation of adhesions from pathological.

The removal of the uterus (hysterectomy) is always accompanied by the formation of connective tissue scars at the places of scars and cuts. The resulting scars are physiological spikes. The scarring of the wound gradually stops, due to which the normal functioning of the organs is restored, and the symptoms of inflammation pass.

Important! The process of formation of adhesions (or scars) after removal of the uterus is normal physiological statehaving nothing to do with pathology. If the formation of the connective tissue does not stop, and fibroids grow and germinate in other internal organs - it is a pathology called adhesive disease. She has its own symptoms and requires serious medical intervention.

These pathological fibroids have a whispering shade. They look like fibrous formations connecting internal organs. The strength of heavyness is high, because of which it has to resort to re-operation to remove them.

The reasons for the formation of adhesions after the removal of the uterus

The spike organism occurs mainly only after extensive operations that require the removal of one or at once two organs. The causes of their occurrence are diverse and depends on a number of factors:

• How long there was an operation.
• Operational intervention.
• The volume of blood loss.
• Internal bleeding in the postoperative period. In this case, there is an active resorption of blood accumulated in abdominal cavityAnd this predisposes to the emergence of adhesions.
• Infection of wounds in the postoperative period.
• Genetic predisposition. This is due to the fact that in the genetically predisposed organism, a special enzyme is not formed, capable of dissolving fibrin overlays, which ultimately leads to the emergence of symptoms of adhesive disease.
• People of asthenic physique.
• In addition, the emergence of adhesions depends on the actions of the Surgeon himself. It is important here how correctly the incision was made which suture materials were used, how professionally the seam itself was imposed.
• There are cases when surgeons left foreign objects In the abdominal cavity. It also predisposes to the development of adhesions after removing the uterus and the emergence of symptoms of adhesive disease.

Symptoms of adhesions after surgery

To suspect the adhesive disease in a woman who recently produced the uterus, it is possible in the following symptoms:

• Nighting or pulling pain at the bottom of the belly, forcing the antalygic (forced) pose. Pains can wear a permanent or periodic character, achieve high intensity.
• Delay and other urination and defecation disorders, up to the absence of urine and feces.
• Symptoms of dyspeptic disorders: pain across the abdomen, meteorism and gas formation, "sheep kal", a feeling of reinforced intestinal peristals and others.
• Subfebrile or febrile body temperature (increase to 38-40 s).
• Feeling of severe pain when taking postoperative scarHis redness and swelling.
• Pain during sexual intercourse. Isolation from a bloody vagina.
• If after removing the uterus, several weeks passed, then when these symptoms, it is necessary to immediately contact the doctor (gynecologist).

Important! The symptoms of adhesive disease is nonspecific. This means that if a woman presents such complaints, then speak with full confidence that she had adhesions in a small pelvis, there can not be any qualified doctor. To confirm the diagnosis, instrumental and laboratory examination methods are necessary.

Diagnostics of the adhesive process in the postoperative period

A preliminary diagnosis is made after careful collection of history, complaints of the patient and symptoms of the disease. To confirm the availability of adhesions, the doctor appoints an additional examination:

• General blood analysis. We are needed to check if you have inflammation in the body. Also estimate the activity of the fibrinolytic blood system.
• Ultrasound of the abdominal cavity and the cavity of a small pelvis. The visual examination method helps with a 100% warranty to say whether there is a sleeping process in a small basin after the uterus removal operation.
• X-ray examination of the intestine with the help of contrasting (color) substances. Auxiliary method that allows us to judge the intestinal passability and the degree of narrowing of its lumen.
• Laparoscopic diagnostics also applies, during which separate adhesions are cut and removed, the question of re-operational intervention is also solved.

Surgical treatment of guns

Mostly adhesive disease is treated operational way. This is due to the fact that conservative treatment is not effective, it is used only as prophylaxis in the postoperative period and to remove the symptoms of the disease.

Application 2 types of operation:

1. Laparoscopic operation. It is carried out with the help of special fiber optic equipment. At the same time, 2-3 small outbreaks are produced on the front abdominal wall leather, and then in these places the abdominal wall is pierced. Through these punctures, access to the abdominal cavity is carried out. The advantage of such an operation is that the dissection of adhesions is carried out under control optical system, with minimal injuries of internal organs. With the help of special laparoscopic tools, fibrous sealers are cut with subsequent hemostasis. Pain and complications after such an operational intervention are extremely rare. The recovery period takes several days, the symptoms of the adhesive process disappear almost immediately, physical activity It is possible the day after the operation.
2. Laparotomy. Shown in two situations:
   • There is no possibility to carry out a laparoscopic operation.
   • The presence of symptoms of an extensive adhesion in the abdominal cavity.

   In this case, it is used to begin with lower access, and then expand it up to 15-20 cm. This is done in order to thoroughly inspect all the organs and remove the split spikes. Such an operation is highly trauma, has risk of occurrence. postoperative complications or recurrence of the disease. The recovery period takes about two weeks.

After the operation of the dissection of adhesions, it is necessary to constantly visit the attending physician to observe the processes occurring in a small pelvis.

Important! No doctor will give a complete guarantee that the adhesive disease will not return to you again. The removal of adhesions is the same operation as the removal of the uterus, which means fibrous thoughts between the authorities may form again. To this not happen, in the postoperative period, follow the recommendations of the doctor and carry out prevention of the disease relapse.

Prevention of adhesion formation

If you are assigned an operation to remove the uterus, carefully go to the selection of the surgeon. The month of the postoperative period depends on it.

What a doctor will do

For wound sewing uses only a solid surgical suture material. This is necessary, since hysterectomy is an extensive and highly traumatic operation. Threads are foreign bodythat will turn the connective tissue and subsequently form the spikes.

Professionally imposes seam when the edges of the wound come into contact all over each other.

Medicase prevention of adhesive disease in the postoperative period. The doctor appoints antibiotics wide spectrum Actions (to prevent infection, suppress inflammation), anticoagulants.

Early appointment of physiotherapy with electrophoresis of enzymes, destroying fibrin (lidase, hyaluronidase and others). They destroy dense adhesions, which contributes to the rapid fuss of the symptoms of the disease.

Dynamic observation after surgery, careful monitoring of the state of the small pelvis organs with ultrasound.

What to do you

Early motor activity is important for the prevention of the adhesive process after the uterus removal operation. The fact is that while walking the intestinal peristalsis is improved, which prevents the development of adhesions.

The second point is the observance of the diet. Exclude salty, sharp, fried, alcohol, carbonated drinks. They violate the digestion, and the intestinal peristalsis weakens. It is necessary to eat up to 6-8 times a day by fractional small portions. It does not overload the intestine, which means it does not distort with fibrous overlaps.

As regards folk methods Treatment, they can be used as an addition to drug therapy and only after consulting the attending physician. For the prevention and treatment of adhesions in folk medicine, preventables and boarants of the plantain, dill, flax seeds, St. John's wort, aloe leaflets are used.

Let's summarize

The adhesive disease violates the physiological functioning of all abdominal organs. It is a consequence of high traumatic operations. The launched forms of adhesive disease can be treated only by the operational way, but it also damages the body. That this does not happen, it is necessary to follow the recommendations of the attending physician in the postoperative period and carry out the prevention of recurrence of the disease. When the first symptoms appear indicating the presence of adhesions in the body, you need to immediately contact the doctor for consultation and subsequent diagnosis.

Video: When to be afraid of sucks? The main symptoms of impending problems

Safety process in the intestine is the most frequent complication of surgical interventions. According to some authors, the spikes after the operation are formed in 95-97% of patients. However, their presence does not give reason to diagnose adhesive disease. The latter occurs only in 2-7% of cases. The rest of the patients spikes exist asymptomatic and do not affect the quality of life.

What is the intestinal adhesion: definition, reasons, classification

The inspiration is a condition characterized by the presence of adhesions in the intestines and accompanied by certain clinical manifestations. The pathological process flowing asymptomaticly, not all authors belong to the concept of "adhesive disease".

Fast disease - a condition characterized by the presence of adhesions in the intestines

There are many classifications described pathology:

• by clinical flow:
  • uncomplicated adhesive disease: asymptomatic, with a predominance of dyspeptic symptoms;
  • complicated: adhesive intestinal obstruction;
• depending on the prevalence of the adhesive process:
  • local shape (spikes within the 1st anatomical area);
  • limited (the process captures 2-4 areas);
  • subtotal (5-8 regions);
  • total (9-12 regions);
• depending on the influence of spying formation on the intestinal function:
  • without disrupting the passage of intestinal content;
  • with a violation of the passage, partial or complete.

This classification also includes items that describe the features of the adhesions themselves, their shape, extension, localization.

Why spikes guts arise

The spike formation process is the response of the body on the injury of the superficial layer of the peritoneum. This is a protective reaction, the purpose of which is to stop the spread of inflammation in the abdomen.

2 leaflets of peritoness are isolated: visceral, covering internal organs, and parietal, lining an abdominal wall from the inside. Between them is a small amount of fluid that prevents them with gluing.

Spikes can form between different leaflets of peritoneum (parietal and visceral) or between the same name. Thus, the intestines loops are subjected to gluing, by other organs ( bubble bubble, uterus, ovarian, etc.), abdominal wall.

Spikes (inspirational disease) are connective tissues between adjacent organs or surfaces

Most often, the sleeping process is detected in a blind intestine that can change its shape and position.

Causes of adhesive disease: Caesarean section, injuries, inflammation, congenital vices and others

• surgical operations. Most often, the spikes are formed after interventions on the organs of the abdominal cavity and small pelvis: appendectomy, operations on the thick intestine, gynecological operations (including caesarean section);
• some diseases: inflammatory (pelvioperitonitis, adnexitis, parameters, etc.), infectious (tuberculosis, chlamydia), endometriosis;
• abdominal injuries;
• some congenital malformations of development: "Harry of Lane" and "Jackson membranes". The first are film formations going to a small pelvis from sigmid gut or distal part of the ileum. "Jackson membranes" most often covered by the right division of the large intestine.

Surgical interventions are the most common cause of the ailment. 2.3-9% of patients suffer from spacing for inflammatory diseases. Injuries and genetic predisposition lead to 1.9-4.7% of cases of adhesive disease.

Operation - the most common cause of adhesive disease

To the damaging peritoneum factors include:

• mechanical injury (use of dry gauze napkins during surgery, exposure to surgical instruments);
• chemical burn due to the ingress of the abdominal cavity of some solutions (alcohol, iodine);
• thermal impact (stop bleeding by diathermocoagulation, the use of laser, electronmose);
• drying peritoneum when contact with air during surgery.

Traumatization leads to violation of the integrity of the peritoneum and activates the process of inflammation. Fibrin falls on damaged areas. It makes it difficult to naturally slide organs relative to each other, which leads to their sticking. Fibrin is destroyed with a special substance - active plasminogen. Inflammation that inevitably accompanies any peritonean injuries leads to the development of inflammatory cytokines. The latter inhibit active plasminogen, preventing the destruction of fibrin.

Attention! If the process of fibrinolysis does not run in the first 3-4 days after damage to the peritoneum, the changes will become irreversible. Fibrin will be replaced by a connecting cloth and a spike will be formed.

In addition, a favorable condition for spacing is a disorder of intestinal motility. Protracted inflammatory processwhich is always present after the operation, especially extensive, leads to atony (disorder of intestinal emptying). There are most part of the intestines most of the time, the surcharged areas do not open, which contributes to their battle.

Signs of uncomplicated adhesive disease

Spikes may not cause unpleasant sensations in the patient. In this case, we are talking about the asymptomatic form of pathology.

The manifestations of adhesive disease include:

• disps symptoms due to intestinal impairment: constipation, sometimes a liquid chair, a rumbling in the stomach;
• pain syndrome. Easy sensations There are and amplified during exercise, errors in the diet. The pain varies in intensity, more often wears the character of spasm. Localization is completely depends on the location of the adhesion.

Pain syndrome - presenter in the clinic of adhesive disease

With the uncomplicated form of stomach soft. Painness can be observed in a certain zone or intensifying with deep pressure. It is often observed a picture (bloating due to the accumulation of intestinal gases). objective signs, the occurrence of which is explained by the tension of adhesions. Here is some of them:

Intestinal obstruction with complicated form of illness

A complicated form of adhesive disease is accompanied by a violation of intestinal content. The obstruction can be partial and complete, chronic and acute. The term "chronic intestinal obstruction" is used in relation to adhesive disease and is characterized by a gradual difficulty of passage of intestinal content. Accordingly, the symptoms rapid increasing acute form Pathology, in this case, develop slowly, for a long period of time.

How to determine the starting of adhesions: x-ray, ultrasound, FGDS, laparoscopy, colonoscopy and other diagnostic methods

Clinical picture of uncomplicated form nonspecific. For adhesive disease as the cause of the patient's suffering, information is indicated about previously transferred operations on the abdominal or small pelvis organs.

In diagnostics, the leading role is assigned tool methods. Laboratory tests usually do not reveal significant changes, in some cases may indicate the inflammatory process in the body.

The following methods are used to diagnose adhesive disease:

• x-ray with barium. The contrast agent can be introduced through the mouth (radoscopy of the esophagus, stomach, small intestine) or the rectum (irrigoscopy). In the first case, there is an opportunity to investigate the gastrointestinal tract on its entire length as barium is moving. The method is mainly applied to inspection of the upper digestive tract. In the second case, a thicker intestine is well visualized. In case of adhesive disease, it is possible to detect an abnormal arrangement of the intestines, their deformation. With partial obstruction, the passage of the contrast agent slows down, with complete - stops at the obstacle level;
• opportunities ultrasound with adhesive disease are limited. Meteorism makes it difficult to visualize internal organs. However, with this study, you can consider spikes coming from the abdominal wall, and see fixed to the last intestinal loop;
• FGDS and colonoscopy in the diagnosis of adhesive disease are non-informative, however, it allows you to detect the accompanying tractology of the gastrointestinal tract;
• laparoscopy is a method consisting in examining the abdomen of the abdomen by introducing a special apparatus to it through a puncture on the front abdominal wall. Allows one to see the spikes, assess the degree of prevalence of the adhesive process, the location of the internal organs and their condition. The method is applied not only for diagnosis, but also for treatment.

A promising way to identify adhesions - virtual colonoscopy. Three-dimensional image of a large intestine is formed based on the results of CT abdominal cavity. At the same time, the doctor receives information about the processes occurring in the intestine, the state of its walls and the formations of extra-investigative localization (spikes).

What methods can be treated by pathology

The main method of therapy of uncomplicated adhesive disease - conservative. Why is it preferable to operation? Compliance with the diets, leaf, the reception of medicines do not solve the problem, only eliminate the symptoms. With a causal factor - spikes - you can fight only surgically. And yet, if exacerbations of adhesive disease are successfully stopped by conservative methods, no one should rush with the operation.

Conservative methods are preferable, but sometimes it is not without surgery

Surgical intervention is in the first place among the causes of spike formation. Repeated operations performed for the separation of adhesions, of course, bring relief. But the intervention, no matter how gentle it, it is stimulated by the adhesion process, and the battles are formed again. For this reason Operations are resorted to operations in cases of windows (acute intestinal obstruction) or planned if the disease does not give in conservative methods Treatment.

Lifestyle: Proper Food, Exercises

An important role in reducing the frequency of exacerbations in adhesive disease plays the right nutrition:

• it is impossible to allow long periods of starvation, it disrupts the intestinal motorcycle. It is better to eat gradually, but often - 4-6 times a day;
• should not be found before bedtime;
• after receiving food, it is impossible to lie, otherwise the activity of the peristaltic will decrease;
• do not use products that enhance gas formation and fermentation: beans, beans, cabbage, grapes, whole milk;
• drink more liquid;
• include in the menu products that stimulate the peristaltics: bread with bran, crackers, fruits with a skin, vegetables (with the exception of those who contribute to the meteorism).

Chair must be regular. Poincomes increase the likelihood of exacerbation.

Gymnastics for adhesive disease

An important place in the therapy of adhesive disease occupies a motor activity. Excessive loads are harmful. Heavy physical work provokes pain attack.

Exercises stimulate peristaltics and improve digestion

However, moderate activity stimulates the peristaltics and improves digestion. To improve the quality of life, patients with adhesive disease are recommended to perform a special complex of the exercise. Here are examples of some exercises:

• source position - sitting on a chair:
  • tilt slopes forward, back and on the parties 4-6 times;
  • tightening the knee to the chest at the collected hands on the sides 4-6 times;
• source position - standing next to the chair:
  • to put the leg on the chair, bend in the knee, then disperse, lean to the straightened leg. Repeat 4-6 times;
• source position - sitting on the floor:
  • hands to take off behind the back and rest in the floor, lift one leg, then the second. Both limbs slowly lower. Repeat 4-5 times;
  • left leg bent in the knee. To lean forward, with his right hand reach the right leg. Repeat the same on the other side. The number of approaches is 4-6;
  • hands to rest in the floor, raise straight legs up, make the "scissors" 20-30 times;
• source position - Loku nor back:
  • hands behind head, legs straight. It is necessary to sit down from this position and make hands on the side 4-6 times;
• source position - Lokia on the side:
  • one hand under his head, the other rests on the floor. Straight legs raise up, omit and bend in the knees. Repeat 4-6 times;
• source position - Lokia on the stomach:
  • at the same time raise left and right leg then right hand and left foot 4-6 times;
  • hands pull forward, raise your hands and legs at the same time and hold in this position 30 seconds;
• source position - standing on all fours:
  • alternate fissance and bending into lumbar Department spine. Repeat 2-3 times.

It is important to remember: if the exercises provoke abdominal pain, their number should be reduced or even stop classes.

Conservative treatment methods: Elimination of pain, bloating, constipation, inflammation

Out of exacerbation therapy aims to normalize the intestinal work. Large importance is the diet and lifestyle. A good effect is provided by physiotherapeutic procedures: mud, paraffin and ozocenite appliques on the abdomen area, intestinal stimulation with ultrasound, ionophoresis. Promotes the improvement of motility and massage (the patient can perform it independently): circular strokes of the front abdominal wall clockwise.

If the patient is bothering constipation, and the observance of the diet does not solve the problem, light laxatives are prescribed. For the regulation of motorcycle gasts you can use drugs vegetable originFor example, Iberogast. It has an anti-inflammatory effect and improves peristality. It is accepted for a long time.

To unload the bowel in the meteorism and constipation, you can resort to enemas. To reduce the abdomen, sorbents are applied - drugs that can bind various substances, including gases, and withdraw them from the body. These funds include:

• Coal activated;
• Ultra-adsorb;

Tablets are accepted as needed.

The main rule: the reception of sorbents should not be combined with the use of other medicines.

Antispasmodics are prescribed to reduce pain: but-shpa, doll.

Another group of drugs is enzymes. These drugs have an anti-inflammatory effect, stimulate the process of fibrinolysis (depletion of adhesions), strengthen the immunity: Flogenzym, Vobenzym.

Ganglioblocators are a group of drugs relaxing a smooth intestinal musculature. These drugs are used with painful form of adhesive disease, accompanied by spasms and intestinal colic. Relief will bring Dimekolin.

Medicines that will help to remove the symptoms of the disease - Photo Gallery

Iberogast - preparation of vegetable origin for the regulation of motorcycle gasts But-shpa is appointed to reduce pain Sorbeks are necessary to reduce the bloating Flogenzym has an anti-inflammatory action

Tactics of treatment with exacerbation and suspicion of obstruction: when you need to do the operation

To determine whether the operation is necessary for the patient, when entering the hospital, the abdominal radiography is necessarily performed in the standing position. The presence of cubebert bowls (cupid shadows in the abdominal cavity) indicates intestinal obstruction. In this case, it is necessary to resolve the question of the feasibility of emergency operation. Dynamic obstruction In most cases, it is possible to resolve conservative methods. However, it is not always easy to distinguish it from the mechanical diagnostics at an early stage.

In the first 2-3 hours after hospitalization, trial conservative therapy. The decompression of the tract:, enema, installation of a nasogastric probe is performed. For relief owl syndrome Undarcotic analgesics, antispasmodics, novocaine blockades are used.

Emergency operation is performed in the absence of a trial effect. conservative treatment

A persistent positive effect of conservative treatment within 2-3 hours a question about the need for surgical intervention. If the signs of obstruction are saved, and / or the deterioration of the state is observed, the operation is performed.

Surgical removal of adhesions: laparotomy, laparoscopy, laser therapy, hydraulic squeezing and other methods

Operations for adhesive diseases are divided into urgent (with obvious obstruction symptoms) and planned (executed in the case when conservative therapy is ineffective). The purpose of emergency intervention - elimination of the obstacle to the passage of intestinal content: separate separation, gut resection in case of its necrosis, creating bypass anastomosis. The latter is shown when a whole portion of the intestine is enclosed in numerous spikes and it is impossible to divide them. In this case, before the surgeon, a choice is a choice: remove the stitching conglomerate or leave it, but sew free sequish sections so that its contents are transported bypassing the obstacle.

Recuracy is traumatic and heavy for a patient operation, besides creating conditions for re-spike formation. Creating anastomosis is a more sparing method.

In addition, laser therapy (dissection with a laser) can be used for separation of adhesions, hydraulic squeezing (destruction using a special fluid, which is injected under pressure).

Emergency operation is always performed in an open way. Medino laparotomy provides good reviewallows you to make an extension to better access if necessary. Unfortunately, the open operation is always accompanied by a high risk of re-spike formation and a recurrence of the disease.

Execution planned intervention Preceded by a course of conservative therapy, the purpose of which is to translate the disease in the stage of remission. The optimal method of surgical treatment in this case is laparoscopic, i.e. without opening the abdominal cavity. When performing planned operations, barrier methods that prevent the combustion of intestinal loops with each other are widely used, with other organs and abdominal wall: mesogel, adept, membrane of the flag.

If the problem arose in a woman after a cesarean section, then doctors recommend not to carry out a laparoscopic operation before breastfeeding, as it complicates the child's care.

An important step in performing a surgery for the adhesive window is the Nazointestinal intubation. The method is to introduce the probe through the nose into the delicious intestine. It contributes to decompression, and also plays the role of a frame for intestines. The latter fit and gently fixed in a physiological position, which improves their functioning and reduces the likelihood of re-obstruction in the formation of adhesions in the postoperative period.

Attention! Non-phantine intubation is a gentle option for intestine sliding, Nobl operations. In the latter case, the intestines are stacked by parallel to each other with rows and fixed with seams in this position. According to the author, it hinders them in a non-physiological position and prevents the emergence of windows in the distant future. However, the operation of the Nobl is trauma and is often accompanied by heavy complications in the postoperative period. The frequency of death after her amounted to 8%, recurrences of adhesive disease - 12%.

Operation to remove adhesions of abdominal cavity - video

Treatment of adhesive disease by folk remedies at home

Infusions and grasses from herbs are able to facilitate the state and eliminate unpleasant symptoms Diseases. However, they do not affect the cause of the illness (spikes). Such treatment is permissible and will help only with the uncomplicated form of illness outside the exacerbation.. Here are examples of some recipes:

• pour hot water 350 grams of Badan root, pre-crushed, insist 8 hours. 2 tbsp. spoons infusion add to 1 liter of boiling water, cool, use for douching in the morning and in the evening;
• 2 tbsp. Spoons of flax seeds, wrapped in gauze fabric, put in boiling water for 3 minutes. Cool, squeeze water. Pouch with seeds to fix for the night to the patient;
• 1 tbsp. Spoon of plantain seeds pour 2 glasses of water, boil 10 minutes, take 1 tbsp. Spoon 3 times a day 2 months.

Folk remedies can be used with uncomplicated adhesive disease outside exacerbation

For better effect, combine methods folk Medicine with the implementation of nutrition recommendations and physical activity. When aggravating the disease, and even more so the development of complications should consult a doctor.

Consequences and complications: acute intestinal obstruction, ectopic pregnancy, infertility

The complications of the described disease include:

Attention! Pregnancy can cause exacerbation of adhesive disease. The growing uterus changes the usual position of the internal organs, shifting them. In this case, the adhesion tension is possible, which will be accompanied by painful syndrome. There may be squeezing the intestinal loops between the battles.

Acute adhesive intestinal obstruction is a few species:

• mechanical (there is an obstacle to intestinal contents):
  • obstructive - the closure of the intestinal lumen due to its squeezing from outside the spike;
  • stagnaya. The obligatory component of this type of windows is to squeezing the bowel of the intestine with blood vessels passing in it;
• dynamic (intestinal function broken):
  • according to the hyperkinetic type (characterized by the active intestinal motor, gravating pains in the abdomen, resembles mechanical obstruction);
  • according to the hypokinetic type (the peristalism is sharply weakened, the stomach will be taken due to the accumulation of a large amount of gases).

Stage increasingness, i.e., due to the cessation of blood supply, is the most dangerous version of the window. Indeed, in this case, necrotic changes in the intestines occur very quickly, intoxication rapidly increases. 68.6% of the deaths of deadly outcomes in adhesive intestinal obstruction were due to such a form of the window.

Clinical manifestations of acute intestinal obstruction:

• abdominal pain;
• delay in the disheaval of the chair and gases;
• nausea and vomiting;
• owl of belly. On the initial stages He is soft, painful in all departments. Often it is possible to detect an asymmetry of the abdomen at the expense of separate sections of the intestine. As the disease progresses, inflammation of the peritoneum develops. The stomach becomes strained.

Acute intestinal obstruction - indication for immediate hospitalization of the patient. If it is impossible to resolve this condition with conservative methods or suspicion of the rage (cessation of the intensity of the intestinal section), an emergency operation is performed.

Prevention during surgery and in the postoperative period

Measures to prevent adhesive disease can be divided into 2 groups:

• prevention of spike formation during surgery:
  • preference should be given to laparoscopic interventions. Classic laparotomy is very traumatic. The risk of adhesions after it is significantly higher than with an endoscopic operation;
  • careful attitude to fabrics. It should be avoided by the extraction of large sequire sections from the abdominal cavity, it contributes to the drying of the peritoneum;
  • careful hemostasis and removal from the abdominal cavity of all blood clots and pathological effusion;
  • restriction of the use of tampons, drainage;
  • washing the abdominal cavity and the cavity of the small pelvis with a solution of ringer (prevention of peritoneal drying);
  • processing of the abdominal cavity by imbuming the formation of adhesions with solutions: novocaine, streptomycin, fibrinolysin, etc.;
  • the introduction of intraperitoneally streptocinase, urchinase, heparin;
  • the use of barrier methods (relevant for scheduled operations for the separation of adhesions): adept, mesogel, membrane of the flag.
• preventive measures in the postoperative period are aimed at combating a bowel atony, stimulation of motility:
  • early activation of the patient (reduction of the duration of the bed regime);
  • intestinal stimulation: Execution of enema, preset injection;
  • the intramuscular administration of the hydrocortisone in the first 3-4 days after the operation followed by replacing the prednisone in tablets. These drugs reduce inflammation, thereby eliminating a significant spacing factor;
  • compliance with the recommendations for nutrition and lifestyle.

The prevention of adhesive disease caused by inflammation of the organs of the abdominal cavity and a small pelvis implies the fight against infection and the spread of the pathological process. It includes adequate treatment of the main disease, antibiotic therapy. If surgery has been conducted, a bastation of the abdominal cavity is played in the relief of inflammation and destroy pathogenic microflora.

With the development of abdominal surgery and an increase in the number of operations performed, the problem of spike formation and the struggle against the consequences of this process is growing. On the this moment The method has not been developed that allows one and forever to get rid of adhesions in the abdominal cavity. Surgery Diseases do not guarantee the lack of relapses in the distant future. Preference is given to conservative methods. Of course, they are unable to destroy spikes, but they can eliminate painful sensations, prevent the occurrence of exacerbations and complications of the disease.

Spikes intestines - These are formation of connective tissue (traction) between the abdominal bodies and intestinal loops, leading to the splicing or gluing of serous membranes of organs among themselves. As a result, they are splicing them between themselves, which entails a wide variety of functional disorders. The trash themselves consist of the same fabric as outer wall intestines. Most often, this pathological process is determined by preceding operational intervention.

According to statistics, if primary laparotomic intervention was carried out on the intestines, the spikes are formed in 14% of cases, and if it is the third operation, they arise in 96% of cases.

To determine the causes of the intestinal income, the mechanism of their occurrence should be understood. It is known that all organs located in the abdominal cavity, including the intestines, are covered with thin leaflets of peritonev. These sheets are smooth and produce a small amount of fluid that provides the intestine mobility. When the impact of a particular factor on the intestines occurs, this leads to the formation of its edema and education on the sheets of the fibrin-plated peritoneum. This flaka has a sticky consistency and contributes to the fact that nearby fabrics are connected to each other. If there is no adequate treatment at the moment there is no time, then in place there was inflammation and bonding, spikes are formed.

They are not formed instantly, but pass through several stages. First, fibrin appears, after 2 days, it will acquire fibroblasts separating collagen. On the 7th day, inflamed fabrics begin to be replaced by connecting. This process is completed after 3 weeks. This time is enough so that the formed battles turned into spikes. In the future, the nerves and capillaries germinate in them.

The causes of the intestine of the intestines are due to the following factors:

The priority cause of the formation of the intestines is surgical manipulations on the organ. This may be an operation to remove appendicitis, a cesarean operation, an operation to remove a polyp or other neoplasm. That is any internal inflammation Intestinal intestinal, which ended with operational intervention can lead to the formation of heavy. Against the background of inflammation infection, while drying the peritoneum during surgery and with other negative factors, the risk of degrades increases.

Belly injuries both open and closed type. Mechanical damage often accompanied internal bleeding. The intestines may occur hematomas, the lymphatic outflow suffers, the metabolic processes in its tissues are disturbed. As a result, blood flow is broken, there is a process of inflammation and a spike is formed.

In women, the spikes of the intestines can be formed due to inflammation of the appendages.

IN childhood Spikes of the intestines can be formed as a result of congenital abnormalities of the body development.

We provoke the adhesion process of foreign bodies in the peritoneum and the reception of some drugs.

Additional risk factors for the formation of intestinal inches are:

Mechanical intraoperative injury;

A bowel tissue ischemia;

Imposition of non-disseminating seams;

Postoperative infection;

Reducing local immunity;

Blood in the abdominal cavity;

Hyperactivity connective tissue as individual feature organism;

The tendency to the formation of adhesions passed by inheritance.

The symptoms of the intestinal adhesions depend on what time the person has intestinal obstruction. She can develop as in early period After transferred operation or injury, or a few later, a few months later or even years after the exposure of the provocateur factor.

Symptoms of early intestinal adhesion disease

Symptoms pointing to the formation of adhesions in the first days after the injury or operation is often triggered by the intervention itself. A person makes complaints on periodically amplifying pain in the abdomen, which in one way or another are present on an ongoing basis. As the pathological process progresses, pain become grasp.

The imposition of bypass anastomosis is performed when the spikes deformed the intestines.

It is important during the operation to fulfill preventive measures aimed at preventing the recurrence of the adhesive process. For this, the cuts make wide, do not allow permanent petals to rehash. Blood must be deleted in a timely manner, and stop the bleeding completely. Income in the wound antibacterial drugs or anesthetics are unacceptable. Stitched with wound with polymer threads. IN obligatory Eliminate the ingress of any foreign particles into the wound.

When the operation turns out to be completed, proteolytic enzymes are introduced inside the peritoneum. The patient shows the reception of drugs from the NSAID group, antihistamine drugs, stimulation of intestinal peristals.

As for the forecast, it is favorable with single spikes. If multiple spikes, then in 15-20% of cases there are re-exploration. To prevent adhesions forming, you need to eat correctly, perform physical exercisesAvoid both overeating and fasting. Treatment of intestinal pathologies should be performed as soon as possible, for which regular inspections are needed by a gastroenterologist. Naturally, the qualifications and professionalism of the doctors conducting the intestinal operation play a leading role in terms of the emergence of adhesions on its surface.




Education: Moscow State Medical and Dental University (1996). In 2003, he received a diploma of the Educational and Scientific Medical Center for the Office of the President of the Russian Federation.

Favoric disease is called a pathological condition characterized by the formation of adhesions from connective tissue in the organs of a small pelvic or abdominal cavity.

It is worth saying that modern world Significantly increased the number of factors affecting the development of this pathology, which is why it is increasingly diagnosed in women of various age categories.

All the complexity of the adhesive disease is that the process of its development itself is absolutely natural, as it happens when the body's protective reaction is triggered.

Why Spikes are formed

The initiators of the adhesive process can be the most different factors. Most often the development of this pathological state contribute to:

• inflammatory diseases of organs located in a small pelvis. These can be various infections of uterus, appendages, etc.:, Parameters, SalpingoForitis and other diseases. These diseases may develop due to prolonged wearing intrauterine spiral, after surgical interventions in the region of the uterus, abortion, genital infections;
• inflammation of the abdominal organs, for example, appendicitis;
• hemorrhage in the abdominal cavity, for example, with ectopic pregnancy;

The mechanism for the development of the adhesive process can be described as follows: when the inflammatory process develops in a small pelvis, there is a swelling of the tissues, and a peculiar flare from fibrin is formed on the peritoneum, which glues nearby fabrics. At the same time, a peculiar obstacle forms to further spread inflammation, but after transferred disease Forms of glued fabric are formed. These are spikes that are pathology, but at the same time perform and protective function, preventing the spread of the inflammatory process.

The formation of adhesions contributes to the displacement of the internal organs, the current of the liquids inside the body is also disturbed. This also applies to the exit of an egg from the ovary and its movement along phallopy tubes.

It is worth understanding that not always inflammatory disease The organs of a small pelvic or abdominal cavity leads to adhesive disease. The timely started treatment is many times reduces the risks of development. As a rule, spikes begin to form when moving the disease from acute stage In chronic when the healing process is delayed.

Basic symptoms of the disease

The severity of clinical manifestations always depends on the degree of propagation of adhesive disease. Sometimes no symptoms may not be at all, in other cases a very pronounced clinical picture will be observed. In medicine, it is customary to allocate the following forms of the adhesive process:

• Acute formwhich is characterized by a gradual increase in pain syndrome, periodic nausea and vomiting, as well as an increase in body temperature. If you press on the stomach, there will be a sharp pain. There may be obstruction of the intestine, after which the condition deteriorates even more and is estimated as very heavy.
• Intermittent formFor which periodic pains are characterized as well as intestinal disorders.
• Chronic form With hidden clinical picture. Symptoms may be absent or disturbing only sometimes. In gynecology, a chronic adhesion process meets most often. He can become, causing obstruction fallopian pipes, as well as lead to other serious complications.

Diagnosis of adhesive process

The diagnosis of adhesive disease includes a number of studies. As a rule, it is possible to suspect pathology already at the first gynecological examination, but the doctor will be able to put a reliable diagnosis after:

• and abdominal cavity;
• MRI of a small pelvis;
• diagnostic laparoscopy, which is the most reliable and informative method.

After conducting high-quality diagnostics and the establishment of the stage of the adhesion, the optimal tactics of treatment is developed.

Methods of treatment of adhesions of the melody pelvis

The treatment of the adhesive process always depends on the severity of the pathology. Depending on the cause that caused adhesive disease, certain drugs are prescribed. In some cases, enzymes can be sufficiently enzyme therapy, which consists in the reception of special fibrinological drugs. Physiotherapy can also be assigned, but it is shown only in cases where there is no acute infectious process.

If the methods described above do not give a positive result, you will have to resort to a more radical treatment tactics. The main and most effective method of treatment is the laparoscopic operation. In the abdominal cavity, small punctures are made through which the tools and the camcorder are entered. Spikes can cut a laser, electric knife or a conventional mechanical manner. After surgery, special barrier fluids are introduced into the abdominal cavity, which prevent the resumption of the adhesive process.

It should be borne in mind that after surgical treatment, adhesive disease can begin again after a while. To this not happen, a special is appointed medical therapy. Surgical treatment of swear disease is carried out strictly according to the testimony, if there is no other effective method Treatment. Sometimes, with a pronounced swear disease, the doctor cannot make a fence of egg for conducting

2017-08-25T22: 48: 24 + 00: 00

What is spikes in gynecology? The adhesion process is fragments of scar tissue, binding 2 organs, which normally should not be connected. For example, intestinal loops and uterus, ovary, uterine pipes.

Spikes can manifest themselves in the form of subtle heavy, barely noticeable at laparoscopy, but they do not rarely look like dense, well-dukeflap. Spikes are developing in response to any impact in the body that require recovery processes. Such exposure include surgery, inflammatory process, endometriosis, injury or impact of ionizing irradiation.

Although the spikes may occur anywhere, one of the most common localizations where they are formed - the small pelvis organs.

The sleeping process and the struggle with its consequences have long been occupied by one of the leading places in abdominal surgery. Spikes in the abdominal cavity are frequent complications of operations and are found in 55-93% of cases after gynecological operations. Spikes in the abdominal cavity are also observed about 10% of people who have never had surgical interventions.
Fortunately, most patients with intra-painted spikes are asymptomatic.

However, the adhesive process of the organs of the small pelvic and the abdominal cavity is associated with a significant gynecological morbidity, including infertility, chronic pelvic pains, subflore obstruction, as well as potential surgical complications in future.
The relevance of the problem today is high as ever, since convincing evidence is obtained that the frequency of clinically significant adhesions after gynecological operations does not decrease, as I would like, and invariably increases, which is manifested in the increased frequency of hospitalization and re-operational interventions related to adhesions process.

This, apparently, is associated with the wide distribution of laparoscopy in gynecology, primarily surgery at infertility, ovarian cysts, endometriosis. In addition, the frequency of Miomectium is growing annually among those women who would have previously offered hysterectomy. Earlier, only highly qualified surgeons were operated on in specialized centers, having microsurgical equipment and thoroughly observing the principles of the prophylaxis of adhesions set out below.

Nowadays, almost any operating gynecologist performs these operations, often neglecting due measurements of prevention.
The adhesion process is considered as a natural consequence of surgical injury and reparation processes. Classical ideas about the causes of the adhesive process allocate several main sources of spike formation, such as injury to tissues of any origin (mechanical, thermal, infectious process, ionizing radiation, reaction to a foreign body, etc.).

Such an injury is a trigger of a cascade of reactions, which begins with the destruction of the fat cells, the ejection of the histamine and increase the permeability of the vascular wall. Then the fibrin is postponed. The healing of the peritoneum is a combination of fibrosis and mesothelial regeneration. Fibrinous sediments are formed within 3 hours after surgery. If Fibrin lysis is not happening - in these clusters germinate blood vessels And fibroblasts migrate.

Most fibrinous sediments are temporary and rested within 72 hours, but the injury caused by the suppression of the destruction of the trousers fibrin leads to the formation of adhesions.
This point of view, which has become classic, has found its confirmation in the series of animal experiments, where the use of silicone membranes, dividing injured peritoneal surfaces for 30 hours, led to a lack of adhesion process.
There are evidence that complement the concept of local desigques.

It is believed that the entire peritonean can be a significant cofactor in the process of forming the adhesive process. The following factors contributing to adhesiogenesis were identified: ascension, hypoxia, acidosis, active radicals of oxygen, as well as tissue manipulation, which leads to an increase in the local formation of adhesions.

Intercoat gel (Oxiplex / AP)

Glossary:

Infiltrative endometriosis refers to clonal diseases. The disease begins with the appearance of single accumulation of endometrial cells, no more than 1 cm.




Doctors bind signs and symptoms of adhesive disease not with problems that appear due to the presence of adhesions in the cavities of a small pelvis, but from the compression of them by organs and tissues, which leads to functional disorders




Intercoat antirefall gel is a transparent viscous disposable gel. It consists of a compound of polyethylene oxide (PEO) and sodium carboxymethylcellulose (CMC).

Questions of patients and answers doctors

Can the spikes dissolve themselves?2017-09-22T17: 28: 44 + 00: 00

Develops from most women after transferred surgical procedures A diagnostic or arapeutic nature and the duration of the disease is divided into acute and chronic.

The "young" adhesive fabric, formed during the first three months after the start of the disease, is sometimes exposed to reverse development as a result of an intensive course of properly selected therapy.

To the one effective species Therapy for adhesive diseases includes physiotherapy and resorption therapy, carried out in combination with anti-inflammatory drugs. Well affects the "young" spikes and hirudotherapy - treatment with leeches, as well as a gynecological massage.

However, in the presence of a chronic adhesion process, destroy the spikes can only surgical treatment, since the adhesive tissue in this case differs in an increased density, the absence of any elasticity and usually does not react to conservative therapeutic methods.

Is it possible to see a small pelvic spikes on ultrasound?2017-09-22T16: 33: 10 + 00: 00

Like many other studies, ultrasound has its advantages and disadvantages.

The benefits of research include its non-invasiveness, painlessness and informativeness.

The disadvantages are the impossibility of determining the recently formed inflammatory tissue - for example, adhesions in the acute stage of adhesive disease. "Young" adhesive fabric has a low density and high plasticity in contrast to mature adhesions in chronic stage Diseases. Therefore, recently formed spikes are practically not visible for ultrasound, especially if they are single.

Mature adhesive cloth is rigid and dense, so it is well distinguishable on the ultrasound.

To clarify the diagnosis of the adhesive disease of a small pelvis, additional examination methods are needed, such as MRI and laparoscopy.

Spikes - What is it? How are they formed?2017-09-12t22: 14: 44 + 00: 00

Sometimes you have to deal with diseases that carry with them bad state of healthBut it is absolutely impossible to understand that this is without the help of a doctor. There is an erroneous opinion that it is better not to have the idea of \u200b\u200bsome ailments for your own calm. But if you know in time about the changes that occur with the body, you can prevent aggravation of the disease. The treatment provided at the right moment will have a beneficial effect. In this article we will talk about the causes of the appearance.

Very thin fibers are formed in the body, and then films capable of gluing nearby organs. Thus, the operation of a specific system is disturbed. Most often, the diseases are suffering a fair sex. Spikes appear mainly in a small pelvis. But sometimes there are in other systems.

One of the most common reasons for the emergence of such a death is inflammation. At this time, any organs increase slightly in size. In the process, liquid begins to stand out. It is such a mucus and turns into thin threads. Subsequently, films are formed - spikes connecting organs among themselves or organ with peritoneum.

If differences between the gel of Intercoat and gel anti-adhesive?2017-09-12t20: 34: 26 + 00: 00

According to antisposher action, drugs are similar. Intercot and anti-adhesive showed positive traits. Both drugs have positive feedback. Both effectively prevent the development of the adhesive process.

Preparations are characterized by a chemical pharmaceutical composition:

• Anti-adhesive : Haloran acid + carboxymethylcellulose. Sometimes it can provoke a tissue reaction to a foreign body, which ends with fibrosis of the surfaces of organs in contact with the barrier means.
• : A barrier antispaste remedy based on a copolymer of carboxymethylcellulose with polyethylene oxide showed in the study the absence of inflammatory reactions and the smallest probability of the manifestation of fibrosis.

And how to use gel? Please send for a doctor for applying2017-09-06T14: 39: 35 + 00: 00

Instructions for the use of antirefront gel Intercate can be viewed on our website.
Also full instruction In Russian is located in each package with gel

Is it possible to have sex with small pelvis spikes?2017-09-22T17: 50: 20 + 00: 00

Sex life with a permanent partner is not contraindicated to women suffering. Full sex has a special therapeutic effect, positively affecting the endocrine and psychological status of both partners.

However, it should be remembered that during the chronic stage of the adhesive process may appear - painful sexual intercourse, when a woman is experiencing repeated painfulness In the area of \u200b\u200bthe abdomen and rectum.

DISARUTIONS is a "visiting card" of adhesive disease and can completely disappear after surgical treatment.

Is it possible to get pregnant in the spikes of the uterine pipes?2017-09-22T16: 23: 03 + 00: 00

The offensive of pregnancy during spikes in uyatar pipes largely depends on the timely diagnosis, individually selected treatment, the full course of examination and the severity of the disease.

Adhesive, chronic infections, as well as endometriosis are able to cause serious inflammation of the mucous membrane in the uterine tubes, which can end with the formation of adhesions. Spikes located in the cavity of phallopy pipes sometimes completely overlap their lumen. In this case, the promotion of the eggs in the pipes becomes impossible and the woman becomes fruitless. However, adhesive disease in the uterine pipes can be expressed in a weaker degree, and then the likelihood of pregnancy is preserved.

How to prevent the occurrence of adhesions?2017-09-06T14: 17: 23 + 00: 00

It was to solve this issue that many scientists and surgeons spent their entire lives.

Today in the world, despite the achievements of modern science and medicine, reliable and high effective tools There are no warnings for the development of adhesions after operations.

Patients complain about abdominal pain, more often in the area postoperative scars. Pains may be laring or dragging, intensifying with exercise, changing the position of the body, to pass independently or after the admission of painkillers.

Sick-shaped Maybe with dysfunction of internal organs. As a result of the adhesive process, the work of the gastrointestinal tract organs is disturbed. Manifestations can be diverse:

• diarrhea
• constipation
• the feeling of bloating after eating,
• the intolerance of some types of food.

How do spikes manifest?2017-09-06T14: 18: 10 + 00: 00

The manifestations of adhesions depend on the place in which fragments were formed and how many them were formed. From this depends to what extent will the functions of the organs that moved among themselves will be disturbed.

The most significant consequences from spike formation occur in the abdominal cavity, so these manifestations are called adhesiveness of the abdominal cavity.