Gallbladder adhesions are bands of internal scar tissue that form in the gallbladder, an internal organ in the abdominal region of humans and many animals. They basically bind the organ to other nearby surfaces like the stomach, liver, or other tissues and membranes. In most cases they are thick and dense, and often require surgery to remove. Medical professionals usually look for ways of removing them promptly because they can compromise organ functioning, but it’s rare for them to actually cause people pain. Some of the conditions that cause them can be very painful, though. Gallstones are one of the most common. Reducing and removing adhesions won’t always make conditions like gallstones less likely, but it may help.
Why They Happen
Adhesions can happen for a number of different reasons. In some cases they form after abdominal surgery, for example, particularly if the gallbladder tissues are exposed or become inflamed during healing. Injury and infection are also common causes, and radiation therapy, which can compromise the integrity of many of the body’s tissues, may also contribute.
By far the most common reason they develop is as a result of gallbladder inflammation caused by gallstones, which is known medically as cholecystitis. The membranes surrounding the gallbladder and helping to hold it in place are formed of many layers, and connective tissue layers are arranged in a regular pattern, resembling woven wicker. If the wicker latticework is damaged, the cells that regrow can be distorted. These distorted cells — irregularly shaped and with weaker structural patterns — form the scar tissue. Gallbladder adhesions can also develop from gallbladder cancer, which is frequently associated with gallstones, and in rarer cases adhesions are attributed to more or less “natural” causes, like genetic defects or family histories.
Where They Occur
The precise placement of the scar tissues usually depends on both the cause and the site of the inflammation. They usually develop between adjacent serous membranes, which are delicate thin tissue sheets. The gallbladder mesentery, which connects the gallbladder to the abdominal wall, is formed out of these thin serous membranes and connective tissue layers. Adhesions developing within a connective tissue layer can be dense, and usually occur as thick fibrous bands. They can involve the cystic ducts, or gallbladder drainage vessels, as well as the liver and pancreatic ducts. They can also involve the peritoneal, or stomach, lining.
Gallbladder adhesions generally do not cause any pain or symptoms on their own, but the conditions leading to their production, such as gallstones and inflammation, can be extremely painful. Gallstones can produce biliary colic, or pain resulting from bile duct blockage by a gallstone. This pain is localized in the upper abdomen and will generally go away in a few hours once the gallstone passes out of the duct.
If it isn’t treated, biliary colic can turn into cholecystitis, which is usually accompanied by the development of inflammation and infection, along with fever and severe abdominal pain. It occurs when an area of impaction by gallstones becomes infected. This can also happen in any blocked duct, such as the hepatic duct of the liver, or the pancreatic duct, which can cause symptoms similar to gallbladder duct blockage. The inflammation associated with cholecystitis and the resulting damage to connective tissue often leads to adhesions.
One of the only ways to treat adhesions is to remove them surgically. Medical experts can often do this with minimal harm by using lasers and laproscopic technology, but accuracy in often depends on knowing exactly where the adhesions are in order to eliminate them in a targeted and precise way. Adhesions can usually be best identified through computed tomography (CT) scans and magnetic resonance imaging (MRI) tests. Removing them often reduces the chance of them recurring, but it doesn’t eliminate it. One of the only ways to completely prevent the possibility of gallbladder adhesions is to remove the gallbladder entirely, which is sometimes recommended for patients who seem to have chronic problems with gallstones, adhesions, or other related problems.
Scar Tissue From Gallbladder Removal
Any surgery to the abdominal region of the body is at greater risk of incurring adhesions, and this includes the gallbladder. Some research has suggested that more than 90% of people who have open abdominal surgery will develop adhesions related to their surgery.
As the body is healing post-surgery, thin sheets of tissue form to create bands of scar tissue. During the healing process, it is not uncommon for the forming band of tissue to bond to a tissue belonging to a nearby organ.
These types of adhesions are less likely to occur with minimally invasive surgeries, such as robotic or laparoscopic. However, it has been estimated that nearly half of patients undergoing minimally invasive surgeries may still experience gallbladder adhesions.
The body experiences less trauma during these types of surgeries, and so there is less scar tissue that needs to form during the healing process. Less scar tissue also means it is less likely to experience complications later, including many years down the road.
The more traumatic the surgery is, the more scar tissue will develop, and in some cases, can continue to develop. This can create additional issues including fertility issues for women.
What Causes Gallbladder Adhesions?
In addition to adhesions that occur during the healing process, gallbladder adhesions following surgery can be caused by things that occur during the surgical process.
- During surgery blood clots can form. If these blood clots are not washed away they may develop into an adhesion.
- Organs may also start to dry during surgery, and this also may cause adhesions to form.
During a minimally invasive surgery, these risks are nearly completely removed since no internal organs are exposed and the trauma experienced to the body is much less severe.
Gallbladder Adhesions Symptoms
Experts point out that it's critical to take notice of any cues coming from your body, especially following surgery.
While gallbladder adhesions following surgery generally won't produce any noticeable symptoms, sometimes they do produce cramps and pain from gas. More serious symptoms include the following:
- painful gas
- inability to pass gas
- a feeling of internal stabbing
- abdominal pain
These symptoms could point to a more severe issue, including a bowel obstruction caused by adhesions.
At the onset of symptoms following surgery, switching to a liquid diet may be all that is needed to get symptoms from adhesion discomfort under control. If symptoms continue to progressively get worse, the patient should speak to their doctor or make a visit to the hospital as soon as possible.
Problematic adhesions will need to be addressed, however, the medical provider will also be cognizant of the fact that any additional surgeries will lead to more scar tissue which could create more adhesions. For this reason, addressing adhesions without surgery will be the first choice for many healthcare providers.
Most adhesions will not develop to such a degree that medical attention is required. In fact, because most adhesions don't cause symptoms, most patients will never know they experienced them.