Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions in children.
OBJECTIVE
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.
Department of Paediatric Surgery and Paediatric Radiology, Women's and Children's Hospital and The University of Adelaide, Adelaide, South Australia.
H L
HL
Tan
K R
KR
Shankar
N
N
Ade-Ajayi
M
M
Guelfand
E M
EM
Kiely
D P
DP
Drake
R
R
De Bruyn
K
K
McHugh
A J
AJ
Smith
L
L
Morris
R
R
Gent
D034861:Abdominal Wall / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D009068:Movement; D011183:Postoperative Complications / Q000175:diagnosis*; D011300:Preoperative Care; D012119:Respiration; D000267:Tissue Adhesions / Q000175:diagnosis* / Q000209:etiology; D014463:Ultrasonography; D014781:Viscera / Q000000981:diagnostic imaging / Q000502:physiology*