Women's Corner
Women's Corner
A) Injury :
- When the the peritoneal surface is exposed to a trauma an inflammatory response occurs at the site of injury leading to loss of mesothelium and an inflammatory response characterised by a :
a. vascular phase (vasodilatation and increased capillary permeability) with the production of an exudats , due to action of mediators of inflammation as
- Cytokines now including TNF, interleukin(IL)-1 , IL-6 and IL-8
- Platelet activating factor
- Arachidonic acid metabolites as PGE2 ,PGI2 leucotriens and thromboxanes
- Humoral defence systems as : complement , kinins and coagulation
- Others : endorphin and histamine
b. Cellular exudate : rich in PNL .
B) Healing :
- Healing tends to occur centripetal
- Peritoneal fluid contains mesothelial cells which tend to cover the defect .
- Healing occurs either by :
a. Fibrinous adhesions , the fate of which is either :
· Lysis within few days by fibrinolysins as plasminogen activators present in the mesothelial cells or subendothelium of the blood vessels converting plasminogen into plasmin causing lysis of the fibrin
· Fibroblastic proliferation if it persists more than 3 days .
b. Fibrous adhesions , composed of mesothelium with connective tissue fibers including elastin and neovascularisaton . Formation of fibrous adhesions is facilitated by :
· Hypoxia : caused by devascularisation, torsion, or ligation. This facilitates formation of adhesions by inhibiting fibrinolysis ..
· Drying of bleeding surfaces : as blood provides additional source of fibrin and cellular elements which makes lysis of adhesions more difficult . Also provides platelet activating factor which adds to the inflammatory process.
· Foreign bodies
dr. Hisham Al-Inany Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt Dr. Amr Hussein Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt