Adhesions

Pathogenesis

• 1. Initial insult
  • Triggered by:
    • Surgery
    • Inflammation
    • Ischaemia
    • Infection
    • Foreign material (e.g. talc, glove powder, sutures)
    • Radiation
• 2. Peritoneal injury
  • Disruption of mesothelial layer
  • Leads to fibrin deposition
• 3. Failure of fibrinolysis
  • Normally fibrin is broken down by fibrinolysis (tPA, plasmin)
  • In injury states tPA is supressed and Plasminogen Activator Inhibitor-1 is upregulated
• 4. Fibroblast infiltration and angiogenesis
  • Fibroblasts migrate into fibrinous exudate
  • Lay down extracellular matrix (mainly collagen)
  • New blood vessels form
  • Leads to mature fibrous adhesions