It’s All Stuck Together

I do expect that to be read in your head to the tune of ‘We all stand together’ by Paul McCartney in 1987. If you don’t know what that is, please Google it and enjoy. However if, while you are searching, you see a link for ‘The Oriental Nightfish’ I would suggest avoid that one. If you know, you know.

The reason for this title is very simple. A few weeks ago I had a particularly challenging case at post-mortem with a huge number of adhesions. I exclaimed our loud ‘It’s all stuck together!’ to which my manager responded with singing to the tune of the aforementioned song. A lot of singing and then having that song stuck in my head for the rest of the day led to the idea for this blog post.

Adhesions are a form of scar tissue which develops after events such as surgery. The bands of tissue are found in many places in the body, but I have most often seen them in the bowel. Minor adhesions will form connections between loops of the bowel which are harmless. The problems can arise when a lot of scar tissue forms which causes the adhesions to constrict and block the bowel. I have seen several cases where the bowel is almost entirely encased in scar tissue, the normal movement completely limited and closer examination required to check to see if any areas are blocked.

In life, severe abdominal adhesions causing problems will present themselves as pain, nausea, vomiting and abdominal bloating. This can be a very serious and complex issue to resolve, requiring surgery in order to repair any damage done. Another apparent sign is the inability to pass wind.

One of the interesting things from an APT perspective is that, although adhesions can make evisceration very complicated and slow, they do give a good indication of a former surgery that we perhaps need to be aware of. For example, we might not have been able to locate a scar but may be able to see clearly that there are adhesions around where an appendix should be but is absent. The same could be sad for the gall bladder or spleen. I recently read a book on the history of transplant surgery where the author, a transplant surgeon, stated that adhesions can form incredibly quickly after surgery and be found on any further surgeries if complications occur.

In addition to the abdomen, there are other areas of the body where the adhesions can form. Any form of heart surgery can cause adhesions around this area, often causing the heart to be ‘stuck’ to the pericardium (the bag that the heart sits in) and even the pericardium to be stuck to the parts of the body around it. I learnt this the hard way when previously removing the sternum from a patient and discovering I was very close to cutting straight through the heart which was sat incredibly close to the surface. Scarring of the lungs can also form a lot of ahesions between the surface of the lung and the chest wall, in these cases it can be very hard to imagine how the lung could inflate with air.

Adhesions are more common than we might all think. If we have ever had any form of surgery we are quite likely to have some form of adhesions. Like I have stated above, sometimes infections and other injuries can form this scar tissue too so slight adhesions could be present in any of us. They only really cause any harm when they constrict or block an organ so it is unable to complete it’s function.

I hope that this has been interesting! I have very largely based it off my own knowledge in what I have learnt during my time as an APT with minimal research apart from the recent book I read which is ‘When Death Becomes Life’ by Joshua Mezrich. This book is a great insight into the world of transplant surgery and I very much enjoyed reading it, check it out if you think you would also like it.

MG x