Publication:

Preoperative ultrasonography in the evaluation of abdominal wall adhesions

Background To detect and document preoperatively the presence of bowel and omental adhesions in the periumbilical region and along the previous abdominal scar using visceral slide scale by ultrasonography, and to compare the ultrasonic findings with intraoperative laparotomy or laparoscopy.

Methods It was a cross-sectional observational study conducted between for 18 months at Guru Teg Bahadur Hospital, Delhi. Patients who had previously undergone abdominal surgery and were subsequently admitted for either laparotomy or laparoscopy (N=100) were selected. All patients underwent ultrasonography for visceral slide evaluation both along the scar and in a radius of 4 cm around the umbilicus. Later, peroperative findings were compared with ultrasonic findings.

Results Mean visceral slide without and with adhesions was 2.39 (±1.21) versus 1.74 (±1.26) cm, correlation being significant (p=0.017) along the scar. While, the mean slide along the scar without and with adhesions in periumbilical region was 2.33 (±1.24) versus 1.07 (±1.07) cm, (p=0.007) on un-paired t-test showing sensitivity=51.6%, specificity=81.15%, positive predictive value=55.2%, and negative predictive value=78.9%. Patients with bowel adhesions (N=3) had restricted visceral slide both in periumblical region and along the scar (1.07 and 0.5 cm respectively).

Conclusions Preoperative ultrasonography using visceral slide is a valuable technique in the detection of abdominal wall adhesions. A slide of ≤1 cm in the periumbilical region strongly suggests bowel adhesions.