182:(SBO) is a significant consequence of post-surgical adhesions. A SBO may be caused when an adhesion pulls or kinks the small intestine and prevents the flow of content through the digestive tract. Obstruction may occur 20 years or more after the initial surgical procedure, if a previously benign adhesion allows the small bowel to twist spontaneously around itself and obstruct. Without immediate medical attention, SBO is an emergent, possibly fatal, condition.
32:
337:, 35% of patients who underwent open abdominal or pelvic surgery were readmitted to the hospital an average of two times after their surgery, due to adhesion-related or adhesion-suspected complications. Over 22% of all readmissions occurred in the first year after the initial surgery. Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures.
121:
cells penetrate into the fibrinous adhesion and lay down collagen and other matrix substances to form a permanent fibrous adhesion. In 2002, Giuseppe
Martucciello's research group showed a possible role could be played by microscopic foreign bodies (FB) inadvertently contaminating the operative field
344:
is particularly susceptible to adhesion formation; one study found that 92% of post-operative adhesions were found in the omentum. It appears that the omentum is the chief organ responsible for "spontaneous" adhesion formation (i.e. no prior history of surgery). In another study, 100% of spontaneous
189:
approximately 2,000 people die every year in the US from obstruction due to adhesions. Depending on the severity of the obstruction, a partial obstruction may relieve itself with conservative medical intervention. Many obstructive events require surgery, however, to loosen or dissolve the offending
105:
may act to limit the extent of the initial fibrinous adhesion, and may even dissolve it. In many cases, the production or activity of these enzymes are compromised because of inflammation following injury or infection, however, and the fibrinous adhesion persists. A more recent study suggested that
170:
Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures. The adhesions start to form within hours of surgery and may cause internal organs to attach to the surgical site or to other organs in the abdominal cavity. Adhesion-related twisting and
92:
deposits onto the damaged tissues. The fibrin then connects the two adjacent structures where damage of the tissues occurred. The fibrin acts like a glue to seal the injury and builds the fledgling adhesion, said at this point to be "fibrinous." In body cavities such as the peritoneal,
317:
An unfortunate fact is, that adhesions are unavoidable in surgery and the main treatment for adhesions is more surgery. Besides intestinal obstructions caused by adhesions that may be seen in an X-ray, there are no diagnostic tests available to accurately diagnose an adhesion.
330:
and that 55–100% of women develop adhesions following pelvic surgery. Adhesions from prior abdominal or pelvic surgery may obscure visibility and access at subsequent abdominal or pelvic surgery. In a very large study (29,790 participants) published in
British medical journal
264:
A meta-analysis in 2012 came to the conclusion that there is only little evidence for the surgical principle that using less invasive techniques, introducing fewer foreign bodies, or causing less ischemia reduces the extent and severity of adhesions in pelvic surgery.
466:
Zindel, J.; Peiseler, M.; Hossain, M.; Deppermann, C.; Lee, W. Y.; Haenni, B.; Zuber, B.; Deniset, J. F.; Surewaard, B. G. J.; Candinas, D.; Kubes, P. (5 March 2021). "Primordial GATA6 macrophages function as extravascular platelets in sterile injury".
313:
has a reduced risk for creating adhesions. Steps may be taken during surgery to help prevent adhesions such as handling tissues and organs gently, using starch-free and latex-free gloves, not allowing tissues to dry out, and shortening surgery time.
839:
Ellis, H.; Moran, B.; Thompson, J.; Parker, M.; Wilson, M.; Menzies, D.; McGuire, A.; Lower, A.; Hawthorn, R.; Obrien, F. (1999). "Adhesion-related hospital readmissions after abdominal and pelvic surgery: A retrospective cohort study".
252:
The impairment of reproductive performance from adhesions may happen through many mechanisms, all of which usually stem from the distortion of the normal tubo-ovarian relationship. This distortion may prevent an
1187:
1160:
388:
There are three general types of adhesions: filmy, vascular, and cohesive, however, their pathophysiology is similar. Filmy adhesions usually do not pose problems. Vascular adhesions are problematic.
706:
Peng, Y; Zheng M; Ye Q; Chen X; Yu B; Liu B (2009). "Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations".
404:
84:. Adhesion formation post-surgery typically occurs when two injured surfaces are close to one another. According to the "classical paradigm" of adhesion formation, the pathogenesis starts with
793:
Liakakos, T; Thomakos, N; Fine, PM; Dervenis, C; Young, RL (2001). "Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management".
305:(FDA) for adhesion prevention: Intercede and Seprafilm. One study found that Seprafilm is twice as effective at preventing adhesion formation when compared to just surgical technique alone.
2585:
122:
during surgery. These data suggested that two different stimuli are necessary for adhesion formation: a direct lesion of the mesothelial layers and a solid substrate foreign body (FB).
767:
368:
may cause adhesion formation. For that reason, it is advised that wrist splints be used only for short-term protection in work environments, but otherwise, splints do not improve
883:
Van Der
Krabben, AA; Dijkstra, FR; Nieuwenhuijzen, M; Reijnen, MM; Schaapveld, M; Van Goor, H (2000). "Morbidity and mortality of inadvertent enterotomy during adhesiotomy".
1039:
Keith, MW; Masear, V; Chung, KC; Amadio, PC; Andary, M; Barth, RW; Maupin, K; Graham, B; Watters WC, 3rd; Turkelson, CM; Haralson RH, 3rd; Wies, JL; McGowan, R (Jan 2010).
2107:
273:
Adhesions forming between the heart and the sternum after cardiac surgery place the heart at risk of catastrophic injury during re-entry for a subsequent procedure.
2578:
281:
Adhesions and scarring as epidural fibrosis may occur after spinal surgery that restricts the free movement of nerve roots, causing tethering and leading to pain.
106:
the formation of "fibrinous" adhesions is preceded by the aggregation of cavity macrophages that may act like extravascular platelets in the abdominal cavity.
2571:
1285:
510:
Torre M, Favre A, Pini Prato A, Brizzolara A, Martucciello G (December 2002). "Histologic study of peritoneal adhesions in children and in a rat model".
741:
289:
Adhesions and scarring occurring around tendons after hand surgery restrict the gliding of tendons in their sheaths and compromise digital mobility.
1789:
1115:
1096:
80:
forms. The term "adhesion" is applied when the scar extends from within one tissue across to another, usually across a virtual space such as the
771:
1384:
1423:
1256:
1009:
676:
644:
1278:
1013:
1651:
1563:
1303:
409:
3372:
186:
3016:
1864:
1271:
3186:
2705:
2536:
2383:
1249:
2281:
301:
during surgery may help to prevent the formation of adhesions. There are two methods that are approved by the U.S.
926:
Weibel, A.; Majno, G. (1973). "Peritoneal adhesions and their relation to abdominal surgery. A postmortem study".
605:"Different surgical techniques to reduce post-operative adhesion formation: A systematic review and meta-analysis"
2891:
2422:
2034:
2017:
1522:
1517:
1394:
1041:"American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome"
151:
2800:
2276:
2232:
2126:
1948:
1547:
2487:
2333:
3402:
3397:
2242:
1761:
1369:
745:
302:
3313:
2842:
1456:
223:
3308:
3041:
2738:
1822:
1751:
1352:
1119:
137:
from moving freely, sometimes causing organs to become twisted or pulled from their normal positions.
3357:
2926:
2095:
2051:
2004:
1810:
1428:
2874:
2693:
2441:
2121:
1756:
1714:
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1402:
1389:
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1206:
3407:
3241:
3191:
3147:
2805:
2366:
2143:
1884:
1676:
1335:
306:
340:
Certain organs and structures in the body are more prone to adhesion formation than others. The
3219:
2795:
2634:
2594:
2446:
2170:
2153:
1537:
1413:
1364:
1325:
1295:
246:
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2297:
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1478:
1090:
377:
365:
603:
Ten Broek, R. P. G.; Kok- Krant, N.; Bakkum, E. A.; Bleichrodt, R. P.; Van Goor, H. (2012).
3236:
2661:
2417:
2361:
2182:
2078:
1661:
1656:
1490:
1408:
1374:
310:
242:
8:
3347:
3286:
3142:
2511:
2321:
2214:
2197:
2158:
2131:
2083:
1926:
1896:
1845:
1817:
1739:
1734:
1729:
1646:
1263:
1191:
249:(also known as intrauterine adhesions, intra uterine synechiae), a cause of infertility.
215:
191:
159:
3214:
3171:
3137:
3073:
3036:
2941:
2832:
2733:
2688:
2644:
2639:
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2388:
2371:
2356:
2343:
2326:
2192:
1827:
1719:
1691:
1625:
1451:
1347:
1312:
1196:
1078:
1065:
1040:
986:
908:
865:
818:
684:
652:
535:
492:
94:
61:
1200:
939:
853:
3412:
3229:
3127:
2810:
2698:
2501:
2482:
1855:
1070:
978:
974:
943:
900:
896:
857:
810:
723:
626:
585:
527:
496:
484:
448:
361:
352:, in which the organs are separated from one another by being floated in a solution.
327:
179:
98:
81:
990:
912:
822:
539:
3352:
3281:
3083:
2911:
2678:
2617:
2548:
2468:
2463:
2453:
2315:
2187:
2115:
1933:
1840:
1835:
1765:
1724:
1532:
1497:
1082:
1060:
1052:
970:
935:
892:
869:
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519:
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298:
53:
3159:
3102:
3011:
2975:
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2715:
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2302:
2237:
2202:
2073:
1938:
1874:
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1695:
1686:
1636:
1576:
1461:
1438:
1211:
1022:
1018:
341:
195:
134:
60:, often as a result of injury during surgery. They may be thought of as internal
57:
210:. In women they typically affect reproductive organs and thus are of concern in
3334:
3196:
3088:
3048:
3026:
2862:
2725:
2710:
2654:
2543:
2458:
2012:
1985:
1850:
1785:
1781:
1671:
1641:
373:
349:
348:
One method to reduce the formation of adhesions following abdominal surgery is
258:
230:
172:
155:
1181:
1177:
1173:
1169:
719:
523:
3391:
3342:
2867:
2852:
2815:
2750:
2668:
2476:
2429:
2222:
2165:
2148:
2060:
1805:
1632:
1507:
1473:
1418:
580:
563:
443:
426:
369:
326:
A study showed that more than 90% of people develop adhesions following open
219:
961:
Colvin, HS; Rajab, TK (June 2010). "Adhesion prevention by hydroflotation".
882:
621:
604:
480:
376:
strength, or bowstringing. Beyond adhesion they also may cause stiffness or
3261:
3114:
2993:
2901:
2879:
2820:
2755:
2683:
2598:
2351:
2263:
2136:
2039:
1990:
1975:
1970:
1966:
1879:
1704:
1620:
1512:
1502:
1468:
1074:
982:
904:
861:
814:
727:
630:
589:
531:
488:
452:
211:
118:
85:
947:
651:. American Society of Reproductive Medicine. February 2002. Archived from
3266:
3181:
3154:
3118:
3064:
2985:
2970:
2896:
2783:
2760:
2649:
2531:
2293:
2271:
2102:
2022:
1666:
1567:
1320:
1230:
1056:
16:
Fibrous bands that form between tissues and organs, usually due to injury
1260:, Science, November 30, 2018, volume 362, issue 6418, pp. 1014-1016
1152:
1008:
3367:
3251:
3201:
3123:
3031:
2962:
2847:
2673:
2307:
1980:
1958:
1603:
1542:
333:
238:
114:
110:
806:
3256:
3246:
3132:
2602:
2257:
2227:
2090:
2068:
1921:
1772:
1746:
1608:
1598:
1485:
1446:
1379:
72:
Adhesions form as a natural part of the body's healing process after
3362:
3068:
1891:
1869:
1581:
602:
1943:
1709:
1613:
1585:
1038:
73:
49:
171:
pulling of internal organs may result in complications such as
3003:
2774:
2409:
2027:
1913:
1164:
465:
309:
therapy may also minimise the incidence of adhesion formation.
207:
126:
125:
While some adhesions do not cause problems, others may prevent
102:
89:
2593:
509:
1859:
1589:
130:
792:
154:(also known as frozen shoulder), adhesions grow between the
31:
254:
77:
1293:
552:
See article at: www.adhesions.org/ardnewsrelease092303.pdf
206:
Pelvic adhesions are a form of abdominal adhesions in the
109:
If this is allowed to happen, tissue repair cells such as
838:
427:"Peritoneal repair and post-surgical adhesion formation"
1051:(1). American Academy of Orthopaedic, Surgeons: 218–9.
561:
424:
292:
1045:
The
Journal of Bone and Joint Surgery. American Volume
345:
adhesion formations were associated with the omentum.
88:
and activation of the coagulation system which causes
1250:
eMedicineHealth: Adhesions, General and After
Surgery
1014:"Five Things Physicians and Patients Should Question"
705:
1142:
683:. Medical Association Communications. Archived from
564:"Clinical implications of postsurgical adhesions"
3389:
925:
420:
418:
64:that connects tissues not normally connected.
2579:
1279:
1385:Esophagogastric junction outflow obstruction
415:
257:from traveling to the fimbriated end of the
1095:: CS1 maint: numeric names: authors list (
1004:
1002:
1000:
960:
562:Diamond, Michael; Freeman, Michael (2001).
2586:
2572:
1424:Esophageal intramural pseudodiverticulosis
1286:
1272:
1026:, American Academy of Orthopaedic Surgeons
681:American Society for Reproductive Medicine
284:
30:
1064:
677:"Adhesion Prevention: A Standard of Care"
645:"Adhesion prevention: a standard of care"
620:
579:
442:
1010:American Academy of Orthopaedic Surgeons
997:
834:
832:
699:
596:
425:diZerega, Gere; Campeau, Joseph (2001).
355:
268:
185:According to statistics provided by the
1118:. Women's Surgery Group. Archived from
744:. Better Health Channel. Archived from
39:Adhesions formed following appendectomy
3390:
1110:
1108:
671:
669:
276:
165:
145:
2616:
2567:
2408:
1652:Small intestinal bacterial overgrowth
1267:
829:
321:
293:Association with surgical procedures
3373:Persistent genital arousal disorder
1105:
768:"Abdominal Adhesions (Scar Tissue)"
666:
201:
152:adhesive capsulitis of the shoulder
140:
13:
649:Medical Association Communications
187:National Hospital Discharge Survey
67:
14:
3424:
3187:Hypoactive sexual desire disorder
2706:Ovarian hyperstimulation syndrome
2537:Spontaneous bacterial peritonitis
2384:Exocrine pancreatic insufficiency
1138:
2282:Secondary sclerosing cholangitis
975:10.1111/j.1463-1318.2009.02132.x
897:10.1046/j.1365-2168.2000.01394.x
1523:Gastric antral vascular ectasia
1518:Portal hypertensive gastropathy
1395:Gastroesophageal reflux disease
954:
928:The American Journal of Surgery
919:
876:
786:
760:
734:
2801:Dysfunctional uterine bleeding
2277:Primary sclerosing cholangitis
2127:Hepatic veno-occlusive disease
1949:Solitary rectal ulcer syndrome
885:The British Journal of Surgery
637:
555:
546:
503:
459:
398:
1:
2334:Sphincter of Oddi dysfunction
940:10.1016/s0002-9610(73)80123-0
854:10.1016/S0140-6736(98)09337-4
770:. Medicinenet. Archived from
391:
360:The long-term use of a wrist
2897:Menorrhagia (hypermenorrhea)
2868:Polymenorrhea (epimenorrhea)
2243:Postcholecystectomy syndrome
1762:Intestinal pseudoobstruction
1370:Esophageal motility disorder
410:Dorland's Medical Dictionary
303:Food and Drug Administration
7:
3314:Pelvic inflammatory disease
224:pelvic inflammatory disease
175:or intestinal obstruction.
101:, a family of fibrinolytic
10:
3429:
3309:Pelvic congestion syndrome
2739:Fallopian tube obstruction
2228:Gallstone / Cholelithiasis
1752:Functional colonic disease
1548:Zollinger–Ellison syndrome
3358:Vestibular papillomatosis
3333:
3326:
3301:
3277:
3210:
3168:
3110:
3101:
3057:
3002:
2984:
2961:
2937:
2927:Metropathia haemorrhagica
2829:
2791:
2782:
2773:
2724:
2625:
2609:
2522:
2401:
2342:
2256:
2213:
2059:
2050:
2003:
1957:
1912:
1798:
1685:
1575:
1562:
1437:
1429:Acute esophageal necrosis
1311:
1302:
1257:Getting adhesions unstuck
1221:
1146:
720:10.1016/j.jss.2008.03.039
609:Human Reproduction Update
568:Human Reproduction Update
524:10.1007/s00383-002-0872-6
431:Human Reproduction Update
38:
29:
24:
2694:Follicular cyst of ovary
1528:Gastric dumping syndrome
1403:Laryngopharyngeal reflux
1390:Diffuse esophageal spasm
383:
76:in a similar way that a
52:bands that form between
3192:Sexual arousal disorder
3148:Candidal vulvovaginitis
2806:Endometrial hyperplasia
2144:Alcoholic liver disease
1677:Bile acid malabsorption
1621:Peptic (duodenal) ulcer
1021:: an initiative of the
481:10.1126/science.abe0595
307:Surgical humidification
285:Peritendinous adhesions
2635:Endometriosis of ovary
2154:Hepatic encephalopathy
1538:Buried bumper syndrome
1469:Peptic (gastric) ulcer
1353:Mallory–Weiss syndrome
1296:human digestive system
581:10.1093/humupd/7.6.567
444:10.1093/humupd/7.6.547
235:dilation and curettage
218:. Other than surgery,
158:surfaces, restricting
133:and other tissues and
3079:Vesicouterine fistula
3022:Cervical incompetence
2947:Recurrent miscarriage
2885:Premenstrual syndrome
2746:Fallopian tube cancer
2379:Pancreatic pseudocyst
2248:Porcelain gallbladder
1360:Zenker's diverticulum
622:10.1093/humupd/dms032
366:carpal tunnel surgery
364:during recovery from
356:Carpal tunnel surgery
269:Pericardial adhesions
3237:Rectovaginal fistula
2662:Poor ovarian reserve
2183:Hepatorenal syndrome
2122:Budd–Chiari syndrome
2079:Autoimmune hepatitis
1904:Intestinal adhesions
1662:Short bowel syndrome
1491:Functional dyspepsia
1409:Esophageal stricture
1375:Nutcracker esophagus
1116:"Adhesions Overview"
1057:10.2106/JBJS.I.00642
311:Laparoscopic surgery
243:endometrial ablation
226:are typical causes.
3403:Disorders of fascia
3398:Medical terminology
3287:Postcoital bleeding
3215:Urogenital fistulas
3143:Bacterial vaginosis
2796:Asherman's syndrome
2322:Choledocholithiasis
2193:Metabolic disorders
2159:Acute liver failure
2132:Portal hypertension
2084:Alcoholic hepatitis
1927:Radiation proctitis
1846:Mesenteric ischemia
1818:Gastroenterocolitis
1647:Blind loop syndrome
1457:Ménétrier's disease
1365:Barrett's esophagus
277:Peridural adhesions
247:Asherman's syndrome
229:Surgery inside the
216:chronic pelvic pain
166:Abdominal adhesions
146:Adhesive capsulitis
25:Adhesion (medicine)
3172:Sexual dysfunction
3138:Atrophic vaginitis
3074:Retroverted uterus
3037:Female infertility
3017:Cervical dysplasia
2942:Female infertility
2734:Female infertility
2689:Corpus luteum cyst
2645:Ovulatory disorder
2640:Female infertility
2497:Undefined location
2488:Grynfeltt–Lesshaft
2389:Pancreatic fistula
2372:Pancreatic abscess
2327:Biliary dyskinesia
2298:Mirizzi's syndrome
1799:Large and/or small
1479:Dieulafoy's lesion
1348:Boerhaave syndrome
1222:External resources
963:Colorectal Disease
687:on 1 December 2018
512:Pediatr. Surg. Int
475:(6533): eabe0595.
190:adhesion(s) or to
3385:
3384:
3381:
3380:
3322:
3321:
3297:
3296:
3230:Obstetric fistula
3128:Vaginal discharge
3097:
3096:
3042:Cervical stenosis
2957:
2956:
2811:Endometrial polyp
2769:
2768:
2699:Theca lutein cyst
2561:
2560:
2557:
2556:
2397:
2396:
1999:
1998:
1856:Bowel obstruction
1558:
1557:
1245:
1244:
1012:(February 2013),
848:(9163): 1476–80.
807:10.1159/000050149
795:Digestive Surgery
748:on 5 October 2015
328:abdominal surgery
322:Abdominal surgery
299:adhesion barriers
214:or as a cause of
180:bowel obstruction
99:synovial cavities
82:peritoneal cavity
43:
42:
19:Medical condition
3420:
3353:Kraurosis vulvae
3348:Bartholin's cyst
3331:
3330:
3282:Vaginal bleeding
3175:
3108:
3107:
3084:Uterine prolapse
2912:Menometrorrhagia
2836:
2789:
2788:
2780:
2779:
2679:Ovarian apoplexy
2623:
2622:
2614:
2613:
2588:
2581:
2574:
2565:
2564:
2549:Pneumoperitoneum
2406:
2405:
2316:Common bile duct
2198:Wilson's disease
2188:Peliosis hepatis
2057:
2056:
1934:Proctalgia fugax
1841:Abdominal angina
1766:Ogilvie syndrome
1715:Pseudomembranous
1573:
1572:
1533:Gastric volvulus
1498:Pyloric stenosis
1309:
1308:
1294:Diseases of the
1288:
1281:
1274:
1265:
1264:
1254:Smith, Orla M.,
1144:
1143:
1132:
1131:
1129:
1127:
1112:
1103:
1100:
1094:
1086:
1068:
1034:
1033:
1031:
1006:
995:
994:
958:
952:
951:
923:
917:
916:
880:
874:
873:
836:
827:
826:
790:
784:
783:
781:
779:
764:
758:
757:
755:
753:
738:
732:
731:
703:
697:
696:
694:
692:
673:
664:
663:
661:
660:
641:
635:
634:
624:
600:
594:
593:
583:
559:
553:
550:
544:
543:
507:
501:
500:
463:
457:
456:
446:
422:
413:
402:
245:) may result in
202:Pelvic adhesions
141:Regions affected
34:
22:
21:
3428:
3427:
3423:
3422:
3421:
3419:
3418:
3417:
3388:
3387:
3386:
3377:
3318:
3293:
3273:
3206:
3169:
3164:
3160:Vaginal atresia
3093:
3053:
3012:Cervical cancer
2998:
2980:
2976:Uterine fibroid
2953:
2933:
2917:Polymenorrhagia
2858:Oligoamenorrhea
2830:
2825:
2765:
2720:
2716:Ovarian torsion
2605:
2595:Female diseases
2592:
2562:
2553:
2518:
2507:Internal hernia
2393:
2338:
2303:Biliary fistula
2261:
2252:
2238:Adenomyomatosis
2233:Cholesterolosis
2209:
2203:Hemochromatosis
2074:Viral hepatitis
2046:
1995:
1953:
1939:Rectal prolapse
1908:
1875:Fecal impaction
1865:Intussusception
1828:Crohn's disease
1794:
1777:Toxic megacolon
1689:
1687:Large intestine
1681:
1626:Curling's ulcer
1579:
1577:Small intestine
1566:
1554:
1462:Gastroenteritis
1433:
1298:
1292:
1246:
1241:
1240:
1217:
1216:
1155:
1141:
1136:
1135:
1125:
1123:
1122:on 20 July 2014
1114:
1113:
1106:
1088:
1087:
1029:
1027:
1023:ABIM Foundation
1019:Choosing Wisely
1007:
998:
959:
955:
924:
920:
881:
877:
837:
830:
791:
787:
777:
775:
774:on 26 July 2017
766:
765:
761:
751:
749:
740:
739:
735:
704:
700:
690:
688:
675:
674:
667:
658:
656:
643:
642:
638:
601:
597:
560:
556:
551:
547:
508:
504:
464:
460:
423:
416:
403:
399:
394:
386:
358:
324:
295:
287:
279:
271:
233:(e.g., suction
204:
196:small intestine
168:
150:In the case of
148:
143:
70:
68:Pathophysiology
20:
17:
12:
11:
5:
3426:
3416:
3415:
3410:
3408:Abdominal pain
3405:
3400:
3383:
3382:
3379:
3378:
3376:
3375:
3370:
3365:
3360:
3355:
3350:
3345:
3339:
3337:
3328:
3324:
3323:
3320:
3319:
3317:
3316:
3311:
3305:
3303:
3299:
3298:
3295:
3294:
3292:
3291:
3290:
3289:
3278:
3275:
3274:
3272:
3271:
3270:
3269:
3264:
3259:
3254:
3249:
3239:
3234:
3233:
3232:
3227:
3222:
3220:Ureterovaginal
3211:
3208:
3207:
3205:
3204:
3199:
3197:Vaginal cancer
3194:
3189:
3184:
3178:
3176:
3166:
3165:
3163:
3162:
3157:
3152:
3151:
3150:
3145:
3140:
3130:
3121:
3111:
3105:
3099:
3098:
3095:
3094:
3092:
3091:
3089:Uterine cancer
3086:
3081:
3076:
3071:
3061:
3059:
3055:
3054:
3052:
3051:
3049:Nabothian cyst
3046:
3045:
3044:
3034:
3029:
3027:Cervical polyp
3024:
3019:
3014:
3008:
3006:
3000:
2999:
2997:
2996:
2990:
2988:
2982:
2981:
2979:
2978:
2973:
2967:
2965:
2959:
2958:
2955:
2954:
2952:
2951:
2950:
2949:
2938:
2935:
2934:
2932:
2931:
2930:
2929:
2921:
2920:
2919:
2914:
2906:
2905:
2904:
2899:
2889:
2888:
2887:
2882:
2872:
2871:
2870:
2865:
2863:Oligomenorrhea
2860:
2855:
2850:
2839:
2837:
2827:
2826:
2824:
2823:
2818:
2813:
2808:
2803:
2798:
2792:
2786:
2777:
2771:
2770:
2767:
2766:
2764:
2763:
2758:
2753:
2748:
2743:
2742:
2741:
2730:
2728:
2726:Fallopian tube
2722:
2721:
2719:
2718:
2713:
2711:Ovarian cancer
2708:
2703:
2702:
2701:
2696:
2691:
2681:
2676:
2671:
2666:
2665:
2664:
2659:
2658:
2657:
2655:Oligoovulation
2652:
2637:
2631:
2629:
2620:
2611:
2607:
2606:
2591:
2590:
2583:
2576:
2568:
2559:
2558:
2555:
2554:
2552:
2551:
2546:
2544:Hemoperitoneum
2541:
2540:
2539:
2528:
2526:
2520:
2519:
2517:
2516:
2515:
2514:
2509:
2504:
2493:
2492:
2491:
2490:
2485:
2472:
2471:
2466:
2461:
2456:
2451:
2450:
2449:
2444:
2433:
2432:
2427:
2426:
2425:
2414:
2412:
2403:
2399:
2398:
2395:
2394:
2392:
2391:
2386:
2381:
2376:
2375:
2374:
2369:
2364:
2359:
2348:
2346:
2340:
2339:
2337:
2336:
2331:
2330:
2329:
2324:
2311:
2310:
2305:
2300:
2291:
2290:
2289:
2284:
2279:
2268:
2266:
2254:
2253:
2251:
2250:
2245:
2240:
2235:
2230:
2225:
2219:
2217:
2211:
2210:
2208:
2207:
2206:
2205:
2200:
2190:
2185:
2180:
2179:
2178:
2173:
2163:
2162:
2161:
2156:
2146:
2141:
2140:
2139:
2134:
2129:
2124:
2112:
2111:
2110:
2100:
2099:
2098:
2088:
2087:
2086:
2081:
2076:
2065:
2063:
2054:
2048:
2047:
2045:
2044:
2043:
2042:
2032:
2031:
2030:
2025:
2015:
2013:Blood in stool
2009:
2007:
2001:
2000:
1997:
1996:
1994:
1993:
1988:
1986:Anal dysplasia
1983:
1978:
1973:
1963:
1961:
1955:
1954:
1952:
1951:
1946:
1941:
1936:
1931:
1930:
1929:
1918:
1916:
1910:
1909:
1907:
1906:
1901:
1900:
1899:
1889:
1888:
1887:
1877:
1872:
1867:
1862:
1853:
1851:Angiodysplasia
1848:
1843:
1832:
1831:
1830:
1820:
1815:
1814:
1813:
1802:
1800:
1796:
1795:
1793:
1792:
1786:Diverticulosis
1782:Diverticulitis
1779:
1770:
1769:
1768:
1759:
1749:
1744:
1743:
1742:
1737:
1732:
1727:
1722:
1717:
1707:
1701:
1699:
1683:
1682:
1680:
1679:
1674:
1672:Milroy disease
1669:
1664:
1659:
1654:
1649:
1644:
1642:Tropical sprue
1639:
1630:
1629:
1628:
1618:
1617:
1616:
1611:
1606:
1595:
1593:
1570:
1564:Lower GI tract
1560:
1559:
1556:
1555:
1553:
1552:
1551:
1550:
1540:
1535:
1530:
1525:
1520:
1515:
1510:
1505:
1500:
1495:
1494:
1493:
1483:
1482:
1481:
1476:
1466:
1465:
1464:
1459:
1454:
1443:
1441:
1435:
1434:
1432:
1431:
1426:
1421:
1416:
1411:
1406:
1400:
1399:
1398:
1392:
1387:
1382:
1377:
1367:
1362:
1357:
1356:
1355:
1350:
1340:
1339:
1338:
1333:
1328:
1317:
1315:
1306:
1304:Upper GI tract
1300:
1299:
1291:
1290:
1283:
1276:
1268:
1262:
1261:
1252:
1243:
1242:
1239:
1238:
1226:
1225:
1223:
1219:
1218:
1215:
1214:
1203:
1184:
1156:
1151:
1150:
1148:
1147:Classification
1140:
1139:External links
1137:
1134:
1133:
1104:
1102:
1101:
1035:, which cites
996:
953:
934:(3): 345–353.
918:
875:
828:
785:
759:
733:
698:
665:
636:
595:
574:(6): 567–576.
554:
545:
502:
458:
437:(6): 547–555.
414:
396:
395:
393:
390:
385:
382:
357:
354:
350:hydroflotation
323:
320:
294:
291:
286:
283:
278:
275:
270:
267:
259:fallopian tube
231:uterine cavity
203:
200:
173:abdominal pain
167:
164:
156:shoulder joint
147:
144:
142:
139:
69:
66:
41:
40:
36:
35:
27:
26:
18:
15:
9:
6:
4:
3:
2:
3425:
3414:
3411:
3409:
3406:
3404:
3401:
3399:
3396:
3395:
3393:
3374:
3371:
3369:
3366:
3364:
3361:
3359:
3356:
3354:
3351:
3349:
3346:
3344:
3343:Vulvar cancer
3341:
3340:
3338:
3336:
3332:
3329:
3325:
3315:
3312:
3310:
3307:
3306:
3304:
3300:
3288:
3285:
3284:
3283:
3280:
3279:
3276:
3268:
3265:
3263:
3260:
3258:
3255:
3253:
3250:
3248:
3245:
3244:
3243:
3240:
3238:
3235:
3231:
3228:
3226:
3225:Vesicovaginal
3223:
3221:
3218:
3217:
3216:
3213:
3212:
3209:
3203:
3200:
3198:
3195:
3193:
3190:
3188:
3185:
3183:
3180:
3179:
3177:
3174:
3173:
3167:
3161:
3158:
3156:
3153:
3149:
3146:
3144:
3141:
3139:
3136:
3135:
3134:
3131:
3129:
3125:
3122:
3120:
3116:
3113:
3112:
3109:
3106:
3104:
3100:
3090:
3087:
3085:
3082:
3080:
3077:
3075:
3072:
3070:
3066:
3063:
3062:
3060:
3056:
3050:
3047:
3043:
3040:
3039:
3038:
3035:
3033:
3030:
3028:
3025:
3023:
3020:
3018:
3015:
3013:
3010:
3009:
3007:
3005:
3001:
2995:
2992:
2991:
2989:
2987:
2983:
2977:
2974:
2972:
2969:
2968:
2966:
2964:
2960:
2948:
2945:
2944:
2943:
2940:
2939:
2936:
2928:
2925:
2924:
2922:
2918:
2915:
2913:
2910:
2909:
2907:
2903:
2900:
2898:
2895:
2894:
2893:
2890:
2886:
2883:
2881:
2878:
2877:
2876:
2873:
2869:
2866:
2864:
2861:
2859:
2856:
2854:
2853:Hypomenorrhea
2851:
2849:
2846:
2845:
2844:
2841:
2840:
2838:
2835:
2834:
2828:
2822:
2819:
2817:
2816:Endometriosis
2814:
2812:
2809:
2807:
2804:
2802:
2799:
2797:
2794:
2793:
2790:
2787:
2785:
2781:
2778:
2776:
2772:
2762:
2759:
2757:
2754:
2752:
2751:Hematosalpinx
2749:
2747:
2744:
2740:
2737:
2736:
2735:
2732:
2731:
2729:
2727:
2723:
2717:
2714:
2712:
2709:
2707:
2704:
2700:
2697:
2695:
2692:
2690:
2687:
2686:
2685:
2682:
2680:
2677:
2675:
2672:
2670:
2669:Mittelschmerz
2667:
2663:
2660:
2656:
2653:
2651:
2648:
2647:
2646:
2643:
2642:
2641:
2638:
2636:
2633:
2632:
2630:
2628:
2624:
2621:
2619:
2615:
2612:
2608:
2604:
2600:
2596:
2589:
2584:
2582:
2577:
2575:
2570:
2569:
2566:
2550:
2547:
2545:
2542:
2538:
2535:
2534:
2533:
2530:
2529:
2527:
2525:
2521:
2513:
2510:
2508:
2505:
2503:
2500:
2499:
2498:
2495:
2494:
2489:
2486:
2484:
2481:
2480:
2479:
2478:
2474:
2473:
2470:
2467:
2465:
2462:
2460:
2457:
2455:
2452:
2448:
2445:
2443:
2440:
2439:
2438:
2435:
2434:
2431:
2428:
2424:
2421:
2420:
2419:
2418:Diaphragmatic
2416:
2415:
2413:
2411:
2407:
2404:
2400:
2390:
2387:
2385:
2382:
2380:
2377:
2373:
2370:
2368:
2365:
2363:
2360:
2358:
2355:
2354:
2353:
2350:
2349:
2347:
2345:
2341:
2335:
2332:
2328:
2325:
2323:
2320:
2319:
2318:
2317:
2313:
2312:
2309:
2306:
2304:
2301:
2299:
2295:
2292:
2288:
2285:
2283:
2280:
2278:
2275:
2274:
2273:
2270:
2269:
2267:
2265:
2259:
2255:
2249:
2246:
2244:
2241:
2239:
2236:
2234:
2231:
2229:
2226:
2224:
2223:Cholecystitis
2221:
2220:
2218:
2216:
2212:
2204:
2201:
2199:
2196:
2195:
2194:
2191:
2189:
2186:
2184:
2181:
2177:
2174:
2172:
2169:
2168:
2167:
2166:Liver abscess
2164:
2160:
2157:
2155:
2152:
2151:
2150:
2149:Liver failure
2147:
2145:
2142:
2138:
2135:
2133:
2130:
2128:
2125:
2123:
2120:
2119:
2118:
2117:
2113:
2109:
2106:
2105:
2104:
2101:
2097:
2094:
2093:
2092:
2089:
2085:
2082:
2080:
2077:
2075:
2072:
2071:
2070:
2067:
2066:
2064:
2062:
2058:
2055:
2053:
2049:
2041:
2038:
2037:
2036:
2033:
2029:
2026:
2024:
2021:
2020:
2019:
2016:
2014:
2011:
2010:
2008:
2006:
2002:
1992:
1989:
1987:
1984:
1982:
1979:
1977:
1974:
1972:
1968:
1965:
1964:
1962:
1960:
1956:
1950:
1947:
1945:
1942:
1940:
1937:
1935:
1932:
1928:
1925:
1924:
1923:
1920:
1919:
1917:
1915:
1911:
1905:
1902:
1898:
1895:
1894:
1893:
1890:
1886:
1883:
1882:
1881:
1878:
1876:
1873:
1871:
1868:
1866:
1863:
1861:
1857:
1854:
1852:
1849:
1847:
1844:
1842:
1838:
1837:
1833:
1829:
1826:
1825:
1824:
1821:
1819:
1816:
1812:
1809:
1808:
1807:
1806:Enterocolitis
1804:
1803:
1801:
1797:
1791:
1787:
1783:
1780:
1778:
1774:
1771:
1767:
1763:
1760:
1758:
1755:
1754:
1753:
1750:
1748:
1745:
1741:
1738:
1736:
1733:
1731:
1728:
1726:
1723:
1721:
1718:
1716:
1713:
1712:
1711:
1708:
1706:
1703:
1702:
1700:
1697:
1693:
1688:
1684:
1678:
1675:
1673:
1670:
1668:
1665:
1663:
1660:
1658:
1655:
1653:
1650:
1648:
1645:
1643:
1640:
1638:
1634:
1633:Malabsorption
1631:
1627:
1624:
1623:
1622:
1619:
1615:
1612:
1610:
1607:
1605:
1602:
1601:
1600:
1597:
1596:
1594:
1591:
1587:
1583:
1578:
1574:
1571:
1569:
1565:
1561:
1549:
1546:
1545:
1544:
1541:
1539:
1536:
1534:
1531:
1529:
1526:
1524:
1521:
1519:
1516:
1514:
1511:
1509:
1508:Gastroparesis
1506:
1504:
1501:
1499:
1496:
1492:
1489:
1488:
1487:
1484:
1480:
1477:
1475:
1474:Cushing ulcer
1472:
1471:
1470:
1467:
1463:
1460:
1458:
1455:
1453:
1450:
1449:
1448:
1445:
1444:
1442:
1440:
1436:
1430:
1427:
1425:
1422:
1420:
1419:Megaesophagus
1417:
1415:
1412:
1410:
1407:
1404:
1401:
1396:
1393:
1391:
1388:
1386:
1383:
1381:
1378:
1376:
1373:
1372:
1371:
1368:
1366:
1363:
1361:
1358:
1354:
1351:
1349:
1346:
1345:
1344:
1341:
1337:
1334:
1332:
1329:
1327:
1324:
1323:
1322:
1319:
1318:
1316:
1314:
1310:
1307:
1305:
1301:
1297:
1289:
1284:
1282:
1277:
1275:
1270:
1269:
1266:
1259:
1258:
1253:
1251:
1248:
1247:
1237:
1233:
1232:
1228:
1227:
1224:
1220:
1213:
1209:
1208:
1204:
1202:
1198:
1194:
1193:
1189:
1185:
1183:
1179:
1175:
1171:
1167:
1166:
1162:
1158:
1157:
1154:
1149:
1145:
1121:
1117:
1111:
1109:
1098:
1092:
1084:
1080:
1076:
1072:
1067:
1062:
1058:
1054:
1050:
1046:
1042:
1037:
1036:
1025:
1024:
1020:
1015:
1011:
1005:
1003:
1001:
992:
988:
984:
980:
976:
972:
968:
964:
957:
949:
945:
941:
937:
933:
929:
922:
914:
910:
906:
902:
898:
894:
891:(4): 467–71.
890:
886:
879:
871:
867:
863:
859:
855:
851:
847:
843:
835:
833:
824:
820:
816:
812:
808:
804:
801:(4): 260–73.
800:
796:
789:
773:
769:
763:
747:
743:
737:
729:
725:
721:
717:
713:
709:
702:
686:
682:
678:
672:
670:
655:on 2018-12-01
654:
650:
646:
640:
632:
628:
623:
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614:
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587:
582:
577:
573:
569:
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558:
549:
541:
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498:
494:
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486:
482:
478:
474:
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454:
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436:
432:
428:
421:
419:
412:
411:
406:
401:
397:
389:
381:
379:
375:
371:
370:grip strength
367:
363:
353:
351:
346:
343:
338:
336:
335:
329:
319:
315:
312:
308:
304:
300:
290:
282:
274:
266:
262:
260:
256:
250:
248:
244:
240:
236:
232:
227:
225:
221:
220:endometriosis
217:
213:
209:
199:
197:
194:the affected
193:
188:
183:
181:
176:
174:
163:
161:
157:
153:
138:
136:
132:
128:
123:
120:
116:
112:
107:
104:
100:
96:
91:
87:
83:
79:
75:
65:
63:
59:
55:
51:
47:
37:
33:
28:
23:
3262:Sigmoidocele
3170:
3115:Hematocolpos
2994:Parametritis
2902:Metrorrhagia
2880:Dysmenorrhea
2833:Menstruation
2831:
2821:Endometritis
2756:Hydrosalpinx
2684:Ovarian cyst
2496:
2475:
2352:Pancreatitis
2314:
2264:biliary tree
2137:Nutmeg liver
2114:
2040:Hematochezia
1991:Pruritus ani
1976:Anal abscess
1971:Anal fistula
1967:Anal fissure
1903:
1880:Constipation
1834:
1705:Appendicitis
1513:Gastroptosis
1503:Achlorhydria
1342:
1331:Eosinophilic
1255:
1229:
1205:
1186:
1159:
1124:. Retrieved
1120:the original
1091:cite journal
1048:
1044:
1028:, retrieved
1017:
966:
962:
956:
931:
927:
921:
888:
884:
878:
845:
841:
798:
794:
788:
776:. Retrieved
772:the original
762:
750:. Retrieved
746:the original
736:
714:(1): 40–47.
711:
707:
701:
689:. Retrieved
685:the original
680:
657:. Retrieved
653:the original
648:
639:
615:(1): 12–25.
612:
608:
598:
571:
567:
557:
548:
518:(8): 673–6.
515:
511:
505:
472:
468:
461:
434:
430:
408:
400:
387:
359:
347:
339:
332:
325:
316:
296:
288:
280:
272:
263:
251:
228:
212:reproduction
205:
184:
177:
169:
149:
124:
119:blood vessel
108:
86:inflammation
71:
45:
44:
3267:Urethrocele
3182:Dyspareunia
3155:Hydrocolpos
3119:Hydrocolpos
3065:Hematometra
2986:Parametrium
2971:Adenomyosis
2784:Endometrium
2761:Salpingitis
2650:Anovulation
2532:Peritonitis
2294:Cholestasis
2272:Cholangitis
2215:Gallbladder
2103:Fatty liver
2023:Hematemesis
2005:GI bleeding
1811:Necrotizing
1740:Lymphocytic
1735:Collagenous
1730:Microscopic
1667:Steatorrhea
1568:Enteropathy
1414:Inlet patch
1336:Herpetiform
1321:Esophagitis
1231:MedlinePlus
778:20 February
752:20 February
742:"Adhesions"
378:flexibility
115:fibroblasts
111:macrophages
95:pericardial
62:scar tissue
3392:Categories
3368:Vulvodynia
3252:Enterocele
3202:Vaginismus
3124:Leukorrhea
3032:Cervicitis
2963:Myometrium
2848:Amenorrhea
2674:Oophoritis
2524:Peritoneal
2502:Incisional
2423:Congenital
2367:Hereditary
2344:Pancreatic
2308:Haemobilia
1981:Hemorrhoid
1959:Anal canal
1897:Infectious
1885:Functional
1720:Ulcerative
1604:Duodenitis
1543:Gastrinoma
969:(6): 606.
842:The Lancet
708:J Surg Res
659:2008-02-08
405:"adhesion"
392:References
380:problems.
372:, lateral
334:The Lancet
239:myomectomy
3257:Rectocele
3247:Cystocele
3133:Vaginitis
2512:Richter's
2469:Spigelian
2464:Obturator
2454:Umbilical
2287:Ascending
2258:Bile duct
2091:Cirrhosis
2069:Hepatitis
2052:Accessory
1922:Proctitis
1773:Megacolon
1747:Dysentery
1657:Whipple's
1609:Jejunitis
1599:Enteritis
1486:Dyspepsia
1447:Gastritis
1380:Achalasia
1313:Esophagus
497:232124644
297:Applying
46:Adhesions
3413:Scarring
3363:Vulvitis
3327:External
3242:Prolapse
3069:Pyometra
2610:Internal
2603:genitals
2442:Indirect
2437:Inguinal
2171:Pyogenic
2116:Vascular
1892:Diarrhea
1870:Volvulus
1836:Vascular
1775: /
1764: /
1725:Ischemic
1692:Appendix
1582:Duodenum
1452:Atrophic
1326:Candidal
1075:20048116
991:21605591
983:19912289
913:12022467
905:10759744
862:10232313
823:30816909
815:11528133
728:18639246
631:22899657
590:11727865
540:26508386
532:12598961
489:33674464
453:11727863
3058:General
2597:of the
2483:Petit's
2459:Femoral
2362:Chronic
2176:Amoebic
1944:Anismus
1710:Colitis
1637:Coeliac
1614:Ileitis
1586:Jejunum
1439:Stomach
1343:Rupture
1212:D000267
1083:7604145
1066:6882524
948:4580750
870:9057821
469:Science
342:omentum
103:enzymes
74:surgery
54:tissues
50:fibrous
3103:Vagina
3004:Cervix
2923:Other
2908:Mixed
2892:Timing
2775:Uterus
2618:Adnexa
2599:pelvis
2477:Lumbar
2447:Direct
2430:Hiatus
2410:Hernia
2262:Other
2028:Melena
1914:Rectum
1397:(GERD)
1236:001493
1197:560.81
1126:23 May
1081:
1073:
1063:
1030:19 May
989:
981:
946:
911:
903:
868:
860:
821:
813:
726:
691:23 May
629:
588:
538:
530:
495:
487:
451:
362:splint
208:pelvis
192:resect
178:Small
160:motion
135:organs
127:muscle
117:, and
97:, and
90:fibrin
58:organs
3335:Vulva
3302:Other
2627:Ovary
2402:Other
2357:Acute
2108:MASLD
2061:Liver
2035:Lower
2018:Upper
1860:Ileus
1696:Colon
1590:Ileum
1405:(LPR)
1201:614.6
1182:N99.4
1178:N99.2
1174:N73.6
1170:K56.5
1079:S2CID
987:S2CID
909:S2CID
866:S2CID
819:S2CID
536:S2CID
493:S2CID
384:Types
374:pinch
131:nerve
2875:Pain
2843:Flow
2601:and
1790:SCAD
1207:MeSH
1192:9-CM
1128:2014
1097:link
1071:PMID
1032:2013
979:PMID
944:PMID
901:PMID
858:PMID
811:PMID
780:2014
754:2014
724:PMID
693:2014
627:PMID
586:PMID
528:PMID
485:PMID
449:PMID
255:ovum
222:and
78:scar
56:and
48:are
2096:PBC
1823:IBD
1757:IBS
1199:,
1188:ICD
1161:ICD
1061:PMC
1053:doi
971:doi
936:doi
932:126
893:doi
850:doi
846:353
803:doi
716:doi
712:151
617:doi
576:doi
520:doi
477:doi
473:371
439:doi
407:at
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