Pathogenesis of intra-abdominal and pelvic adhesion development

Anthony N. Imudia, Sanjeev Kumar, Ghassan M. Saed, Michael P. Diamond

Research output: Contribution to journalReview articlepeer-review

62 Scopus citations


Abdominal and pelvic adhesions are a frequent occurrence and are responsible for significant morbidity resulting in abdominal and pelvic pain, infertility, and small bowel obstruction. The process of adhesion development begins when damage to peritoneal surfaces from any source (operative trauma, infection, foreign bodies, desiccation, irradiation, allergic reaction, or chemical injury) induces a series of biochemical/molecular biologic cascades involving different elements. These elements include peritoneal fluid, neutrophils, leukocytes, macrophages, cytokines, mesothelial cells, and tissue and coagulation factors, which ideologically have the intention of peritoneal repair; however, these processes also result in adhesion development. Major pathways that play significant roles in the healing process of peritoneal damage leading to adhesion development are the fibrinolytic system, extracellular matrix deposition, growth factor and cytokines, cell adhesion molecules, angiogenesis, apoptosis and proliferation, and remesothelialization. Greater understanding of the regulation and interaction of these processes provides the potential for reduction of postoperative adhesion development.

Original languageEnglish (US)
Pages (from-to)289-297
Number of pages9
JournalSeminars in Reproductive Medicine
Issue number4
StatePublished - Jul 2008
Externally publishedYes


  • Adhesion re-formation
  • De novo adhesion formation
  • Development
  • Intra-abdominal
  • Pathogenesis
  • Pelvic
  • Postoperative adhesions

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Reproductive Medicine
  • Endocrinology
  • Obstetrics and Gynecology
  • Physiology (medical)


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