FIBRINOLYSIS IN THE PERITONEAL-FLUID DURING ADHESIONS, ENDOMETRIOSIS AND ONGOING PELVIC INFLAMMATORY DISEASE

The concentrations of the specific activators (u-PA and t-PA) and the specific inhibitors (PAI-1 and PAI-2) of the fibrinolytic system were analyzed in the peritoneal fluid in women suffering from intra-abdomin al adhesions, endometriosis or pelvic inflammatory diseases (PID). Per itoneal fluids were collected from ten women in whom a laparotomy was performed and an additional 108 in whom a laparoscopy was carried out. In comparison with the normal control patients all activators and inh ibitors were significantly increased in cases of PID and when a second -look laparoscopy was performed one week after laparotomy with adhesio lysis. At laparoscopies, when adhesions were verified, u-PA in the per itoneal fluid was significantly increased and in cases of endometriosi s PAI-2 was significantly reduced. The start of a laparotomy in order to remove adhesions, initiates a process, resulting in a significant i ncrease of PAI-2 antigen in the pelvic fluid. The results imply that t he fibrinolytic system is comprehensively activated in the peritoneal cavity during ongoing inflammatory reaction, and after adhesiolysis. T he increase in plasminogen activators in the peritoneal fluid in estab lished cases of pelvic adhesions or endometriosis may indicate that th e fibrinolytic system is continuously active to inhibit the further fo rmation of adhesions.