Peritoneal adhesions and their relation to abdominal surgery: A postmortem study

TLDR: Peritoneal adhesions were studied with regard to incidence, distribution, and pathogenesis, confirming the importance of microscopic foreign bodies as well as the role of another recently described mechanism, coagulation of blood on an injured peritoneal surface.

Abstract: Summary In 752 consecutive autopsies, peritoneal adhesions were studied with regard to incidence, distribution, and pathogenesis. Adhesions were found in 67 per cent of the subjects who had undergone laparotomy and in 28 per cent of those who had not (the latter adhesions, called “spontaneous,” were presumably caused by foci of inflammation). The incidence of adhesions after minor, major, and multiple operations was 51, 72, and 93 per cent, respectively. Their topographic distribution, summarized in a scheme for each type of operation, points out the importance of surgical trauma as a causative factor. Histologic study confirmed the importance of microscopic foreign bodies (not only talcum powder, but also fluff from gauze pads and so forth) as well as the role of another recently described mechanism, coagulation of blood on an injured peritoneal surface. As regards constitutional factors, short women who were also obese were especially prone to postoperative adhesions; in men this tendency was less marked. Spontaneous adhesions were more frequent in heavy women; in men there was no difference. Age did not affect the incidence of postoperative adhesions, but there was an increase of spontaneous adhesions after the age of sixty. Sex played a role in that women had 4 per cent more adhesions. Ascites had no inhibiting effect. Preventive measures are briefly reviewed.