Ovaries

Endometriosis

Uterus

Endometrial Polyps

Cervix

Appendix

Uterosacral nerve ablation

OB Images

Pelvic Adhesions (scar tissue)/Pelvic Inflammatory Disease

Pelvic adhesions are bands of scar tissue that form between organs in the pelvic area. They are caused by infection, inflammation, endometriosis, or as areas heal from surgery. In many cases these adhesions are painless and the patient never knows she has them, while in other cases they cause a sharp, pulling type of pain, or pain with intercourse or bowel movements.

Pelvic adhesions can be filmy (kind of like sheets of saran wrap), or thick. Some contain small blood vessels. If they involve the fallopian tubes, they can cause infertility or lead to tubal (ectopic) pregnancies. If they are above the liver they can cause pain with deep breathing. If near the vagina, there can be pain with intercourse. And, if they involve the intestines, there can be pain with exercising, reaching for objects above one's head, or when stretching.

They are diagnosed by laparoscopy (putting a thin tube in the belly button to look around the pelvic area during surgery), and are treated by cutting with small scissors or other cutting devices. Unfortunately, sometimes they return, and in these cases either further surgery, or treatment with various pain medications is used. Gynecologists know that for reasons we don't understand the female organs tend to produce scar tissue when irritated. For this reason, we take great care in handling these organs and tissues during surgery, to minimize the chance of scar tissue formation.

Click on the hyperlink below to view the larger JPG image of pelvic adhesions.

Pelvic Adhesions Due to Pelvic Inflammatory Disease
These filmy and vascular adhesions lie between the omentum (a layer
of fatty tissue surrounding the intestines) and the area under the left
groin. The tissue the adhesions are "sticking" to should be smooth.
However, in this patient inflammation has made the tissue "bunched
up" and roughened.

Adhesions Between Intestines and Top of Abdomen
Vascular adhesions between the intestines and thetop of the abdomen. Before cutting, the tinyblood vessels must be burned (cauterized) first, or
they may bleed heavily

Laparoscopic Scissors, Cutting Adhesion Band
In this photo, laparoscopic scissors are placed through a cut about as big around as a pencil eraser in this patient's groin area. They are used to cut the thick band of scar tissue from the omentum to the right side of the
uterus. The right tube is visible to the far right of the photo.

Adhesions Between Liver and Diaphragm Due to PID
Notice the many adhesion bands between the liver and the diaphragm. These are called "violin string" adhesions, and are also called Fitz-Hugh-Curtis syndrome, after Dr. Fitz-Hugh and Dr.Curtis, who reported this condition. The adhesions are usually due to either chlamydia or gonorrhea infections. The bacteria travel up the right side of the abdomen, and collect in the fluid above the liver. Some patients report pain in the right, upper area of the abdomen, but this patient did not have any symptoms in this area. These were treated by cutting during laparoscopy.