Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions in children

• Published in: Journal of pediatric surgery Vol. 38; no. 5; pp. 714 - 716
• Main Authors: Tan, H.L., Shankar, K.R., Ade-Ajayi, N., Guelfand, M., Kiely, E.M., Drake, D.P., de Bruyn, R., McHugh, K., Smith, A.J., Morris, L., Gent, R.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-05-2003; Elsevier
• Subjects: Abdomen; Abdominal Wall - diagnostic imaging; abdominal wall adhesions; Adolescent; Biological and medical sciences; Child; Child, Preschool; Female; Humans; Infant; Laparoscopy; Laparotomy; Male; Medical sciences; Movement; Postoperative Complications - diagnosis; Preoperative Care; Respiration; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue Adhesions - diagnosis; Tissue Adhesions - etiology; Ultrasonography; Viscera - diagnostic imaging; Viscera - physiology; visceral slide; abdominal wall adhesions; Laparoscopy; visceral slide; ultrasonography; Sonography; Human; Postoperative; Adhesion; Abdominal disease; Echography; Abdominal wall; Complication; Endoscopy; Child
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/jpsu.2003.50190

Background/Purpose: Viscera stuck to the anterior abdominal wall from previous surgery risk injury during laparoscopic surgery. A prospective study was conducted to determine if these adhesions are detectable on ultrasound scan by showing a reduction in the normal visceral slide. Methods: Patients undergoing laparoscopic procedure after a previous laparotomy underwent preoperative real-time ultrasound scan to observe if viscera slides freely under the abdominal wall. A reduction in slide was considered a positive sign of underlying adhesions. These findings were correlated with the operative findings. Results: Anterior abdominal wall scans were performed on 17 children. Reduced visceral slide was seen in 10. Viscero-parietal adhesions were found in 9 of 10 patients. Visceral slide was reduced in a very localized area in 6 patients, and, in these, a loop of bowel (n = 3), liver and bowel (n = 2), or liver (n = 1) was adherent. In 4, reduced visceral slide was seen over a wide area. Extensive adhesions were found in 3 of 4. One renal transplant patient with peritonitis had a false-positive ultrasound scan. At laparotomy there were no adhesions. The peritonitis is thought to have prevented an adequate examination. Seven patients had normal visceral slide. Of these, 4 had no adhesions, but 3 children had flimsy omental adhesions. The sensitivity and specificity of visceral slide in predicting adhesions were 75% and 80%, respectively. Conclusions: Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions. Ultrasonographic mapping of the abdominal wall may be useful in selecting an adhesion-free site for trocar insertion in children with previous operations requiring laparoscopic procedures. J Pediatr Surg 38:714-716. © 2003 Elsevier Inc. All rights reserved.