Abstract
Postoperative fibrotic band formation is a common complication that causes bowel obstruction,
chronic pain, and especially reoperation problems. We tried to evaluate the ultrasound
signs of different adhesions over time in children. This descriptive study was performed
in children hospital of Mashhad University of Medical Sciences. Sixty-five children
aged 4 months to 15 years (mean age of 7.2 ± 6.5 years) were enrolled in the study.
Complete abdominal sonography using 5 to 12 MHz multifrequency probes was performed
by a pediatric radiologist. The sonographic findings and data analysis were performed.
In first week after surgery, the fibrinous exudates are seen as hypoechoic shadows.
It has uneven thickness and usually encases the bowel loops in a circular shape. In
second week, they gradually become straighter with uniform thickness. In this period,
in 68% of cases, a hyperechoic line is formed in the center of hypoechoic fibrinous
exudates, which is usually placed between the bowel loops (interloop fibrosis). The
omentum or mesentery entrapment in the fibrinous exudates was occurred in ∼50% and
25% of these cases, respectively. In this state, echogenic omentum or mesentery was
seen simultaneously with the hypoechoic fibrinous exudates. After 1 month from surgical
procedure, One of the following four sonographic patterns are seen: attachment hyperechoic
omentum to retroperitoneum (50%), attachment hyperechoic mesentery to anterior abdominal
wall (26%), interloop fibrosis (39%), and severe hypoechoic fibrotic band (30%). Absence
of visceral sliding was seen in 65 to 80% of patients. Overall, there are five morphologic
patterns of adhesion on ultrasound: fibrinous exudates, interloop fibrosis, fibrotic
band, fixed omentum to retroperitoneum, and fixed mesentery to abdominal wall.
Keywords
adhesion band - sonography - children
