J.Jpn. Surg. Soc.. 59(4): 499-531, 1958
MORPHOLOGICAL AND EXPERIMENTAL STUDY ON PERITONEAL ADHESION, PARTICULARLY ON CORD-LIKE ADHESION AND CLINICAL OBSERVATION OF INTESTINAL OBSTRUCTION DUE TO ADHESION.
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Department of Surgery, Branch Hospital, Faculty of Medicine, University of Tokyo Director: Tamotsu, FUKUDA and Takeo, HAYASHIDA Late Professor of the University of Tokyo and Professor of the Univerrsity of Tokyo Hideo SHIBATA |
In the causative factors of peritoneal adhesions surgical operations or inflammatory processes are most important. In this study, therefore, adhesive processes caused by experimentally induced peritonitis or injuries were observed in experimental animals, and clinical material of adhesive structure particularly of cord-like adhesion or omental cord was studied.
Results were following :
1) Mechanical injuries, if they are slight and not extensive, caused little or no peritonaI adhesion, where fixed contact of the peritoneum facillitated adhering if it was allowed to continue a longer period. Injuries in both sides of contacted peritoneal surfaces are much more successful to make adhesion than injuries of one side.
2) Five per cent iodine tincture caused adhesion easily, whereas 2 per cent aqueous solution of merculochrome provided hardly any adhesion.
3) Localized bacterial peritonitis predisposed much higher rate of post-appendectomy adhesion in experimentally induced appendicitis than in appendectomy for normal animals.
4) Intra-peritoneal blood, air or peritoneal desiccation themselves had no concern with the production of adhesion.
5) Gelatinous adhesion initiated by peritoneal injuries became firm but within 4-5 days, natural detachment may occur by intestinal movements.
6) Peritoneal adhesions were classified in view of clinical surgical standpoint :
i) Congenital adhesion
ii) Aquired adhesion
a) Postoperative
b) Non-postoperative
Non-postoperative adhesion occurs mostly after inflammatory processes in which tuberculous peritonitis is predominant, and the majority of postoperative adhesions occurs after operations for inflammatory diseases.
7) Macroscopic classification of adhesions are following :
1) Surface adhesion
2) Membranous adhesion
3) Cord-like adhesion
4) Omental adhesion
8) Cord-like adhesions are classified microscopically as follows:
1) Fibrinous
2) Of granulation tissue
3) Fibrous
1) and 2) are the names not used previously. 1) is seen to be a product of inflammatory and its destiny is not known. 2) was found in a few cases when inflammation and foreign body existed. 3) is most common type which shows poorly vascularized cicatrical structure, though, in a few cases, well vascularized structure was found.
9) Cord-like adhesion originated from surface adhesion with continuous tension and requires certain period to form. In this case, subserous connective tissue as well as muscle fibers of the muscularis of intestinal wall can proceed into the adhesive tissue.
10) Omental cord-like adhesion is defined as fibrosis of omental tissue. The fibrosis is more apparent in marginal part than in center. This type of adhesion is strongly effected by tension. If there exists no inflammatory process, the strength and duration of tension difine the grade of fibrosis.
Chapter II. Clinical Observation of Intestinal Obstructiou due to Adhesion
One hundredand thirty cases of intestinal obstruction due to peritoneal adhesion were investigated and causes and provocative mechanisms were studied statistically. Results were following :
1) Intestinal obstruction due to postoperative adhesions were seen most common after appendectomies. Early postoperative obstruction is always caused by surface adhesion. Three weeks after operation kinking by cord adhesion increased as the day passed.
2) Obstructions due to non-operative adhesion were mostly caused by inflammatory processes in which the tuberculous peritonitis was the dominantly frequent disease.
3) Obstructions due to cord-like adhesions were mostly constrictive and the frequent mechnisms of onset was ringconstriction or internal incarceration and a few cases of rotation, compression, bending or torsion were seen.
4) Obstructions due to surface adhesions or bending were mostly compressive in nature. The frequent mechanism was adhesion or bending and a few occasions of rotation or internal incarceration were seen.
5) Localization of obstruction was most frequent in the small intestines particularly in the lower part of the ileum.
(author's abstract)
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