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April 3, 1967

Adhesion Pain and The Peritoneoscopist

Author Affiliations

East Orange, NJ

JAMA. 1967;200(1):84. doi:10.1001/jama.1967.03120140142042

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To the Editor:—  Uncertainty over how much abdominal pain can properly be blamed on peritoneal adhesions has added to the difficulties of abdominal diagnosis for years. It is my understanding that in most centers undergraduate teaching continues to deemphasize adhesions as a source of chronic and recurrent pain. Certainly surgical lysis of adhesions for any reason other than bowel obstruction continues to be in disfavor. The matter is extraordinarily difficult to study in any precise way.The peritoneoscopist is likely to be a believer in adhesion pain, provided it is carefully and conservatively defined. Certainly, at least, he is in a good position to judge adhesion sensitivity in the individual patient: he can manipulate and stretch certain adhesions under direct vision, simultaneously observing the subjective pain response. Only adhesions that have one attachment to the anterior abdominal wall or to the anterior portion of the diaphragm can be so studied.