[So-called "dense-vascularised" peritoneal adhesions: clinical and aetiopathogenetic considerations].
In the daily clinical practice of surgeons operating electively or, more frequently, in the emergency setting, within the abdominal cavity and pelvis, the detection of an intestinal adhesive disorder is frequent and is capable of causing numerous complications and subsequent reintervention. We report three cases of female patients referred to our observation for bowel subocclusion due to adhesive syndrome. After laparotomy, which revealed the presence of singular tenacious fibrovascular adhesions, the patients were subjected to immunohistochemical and receptor analysis yielding a diagnosis of leiomyomatosis peritonealis disseminata. The simultaneous combination of high levels of exogenous female hormones (hormone replacement therapy or prolonged exposure to oral contraceptives) or endogenous hormones (as happens during pregnancy), a genetic predisposition (including genetic malformations) and previous surgery (peritoneal trauma), as evidenced in our patients, all seem to play a key role in the pathogenesis of so-called "dense-vascularised", particularly tenacious adhesions responsible for the activation of multipotent mesenchymal submesothelial peritoneal cells. This striking macroscopic picture, when related to the anatomico-pathological description, is the basis of the pathological entity known as leiomyomatosis peritonealis disseminata.
Scuderi
Stefano
S
VI Divisione di Chirurgia Generale, Azienda Ospedaliera S. Giovanni Battista, Torino.
Giaccone
Michele
M
Falletto
Ezio
E
Fronticelli
Carlo Maria
CM
Maorenzic
Marcela Alejandra
MA
Seghesio
Raffaele
R
Gaetini
Alessandro Maria
AM
D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D018231:Leiomyomatosis / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D012307:Risk Factors; D000267:Tissue Adhesions / Q000209:etiology* / Q000473:pathology*
D003278:Contraceptives, Oral, Hormonal