Practice of Peritoneal Adhesions in Osteopathic Medicine: Part 2

Abstract

Peritoneal adhesions are an unwanted and frequent event following abdominal surgery, with a response rate that can reach 100%. The adhesions can be symptomatic, becoming a source of pain and discomfort for the patient, or asymptomatic, with possible chronic or acute visceral dysfunction. The article reviews what the diagnostic strategies are and discusses what could be the causes that lead to chronic pain in the presence of adhesions. The text reports the knowledge of the literature on the manual treatment of adhesions and illustrates possible symptoms that are not easily recognized by the clinician. To conclude, the article proposes osteopathic manual approaches derived from clinical experience and from what has been explained about the formation of peritoneal adhesions. Research must make further efforts to identify not only the causes triggering the formation of peritoneal neogenesis but also seek the most appropriate non-invasive treatments to help the patient.

Keywords: fascia; manual therapy; myofascial; osteopathic manipulation; osteopathy; peritoneal adhesions; surgery.

Figure 1. The image (from laparotomy) shows the presence of adhesion formations (translucent tissue) between the parietal peritoneum and the adipose tissue, in the absence of previous abdominal surgery.

Image by Bordoni Bruno.

Figure 2. The image shows a horizontal scar (red arrow) on the right lower quadrant of the abdomen from previous ureteral surgery. On palpation, below the scar, the tissue appears dense and painful, with the probable presence of peritoneal adhesions.

Image by Bruno Bordoni.

Figure 3. The image shows the operator with one hand on the area of possible adhesions and one hand under the cervical area. The technique applied is an indirect or listening technique, without inducing any movement; the technique is finished when the palpated tissues have a significant decrease in the tension felt (the tissues "melt").

Image by Bruno Bordoni.

Figure 4. The image shows the operator placing a hand on the site of possible adhesion, and with the other hand holding the lower limb (in this case ipsilaterally) in the most optimal position to warn that the abdominal area under palpation is comfortable or with "zero" tension. The technique ends when the tissue under the palm of the hand is "dissolved."

Image by Bruno Bordoni.