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CC BY 4.0 · Journal of Child Science 2022; 12(01): e138-e143
DOI: 10.1055/s-0042-1757152
Original Article

Ultrasound Changes of Postoperative Adhesion Types Over Time in Children

Seyed Ali Alamdaran
1   Clinical Research Development Unit, Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
,
Seyed Hamidreza Vahed
2   Radiologist, Mashhad University of Medical Sciences, Mashhad, Iran
,
Golnaz Seyedin 
3   Surgen, Mashhad University of Medical Sciences, Mashhad, Iran
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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


Publication History

Received: 04 October 2021

Accepted: 14 July 2022

Article published online:
29 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: a practical review of an often overlooked entity. Ann Med Surg (Lond) 2017; 15: 9-13
    CrossrefPubMedGoogle Scholar
  • 2 van den Beukel BA, de Ree R, van Leuven S. et al. Surgical treatment of adhesion-related chronic abdominal and pelvic pain after gynaecological and general surgery: a systematic review and meta-analysis. Hum Reprod Update 2017; 23 (03) 276-288
    PubMedGoogle Scholar
  • 3 Al-Salem AH, Oquaish M. Adhesive intestinal obstruction in infants and children: the place of conservative treatment. ISRN Surg 2011; 2011: 645104
    PubMedGoogle Scholar
  • 4 Fredriksson F, Christofferson RH, Lilja HE. Adhesive small bowel obstruction after laparotomy during infancy. Br J Surg 2016; 103 (03) 284-289
    CrossrefPubMedGoogle Scholar
  • 5 Lienemann A, Sprenger D, Steitz HO, Korell M, Reiser M. Detection and mapping of intraabdominal adhesions by using functional cine MR imaging: preliminary results. Radiology 2000; 217 (02) 421-425
    CrossrefPubMedGoogle Scholar
  • 6 Katayama M, Masui T, Kobayashi S. et al. Evaluation of pelvic adhesions using multiphase and multislice MR imaging with kinematic display. AJR Am J Roentgenol 2001; 177 (01) 107-110
    CrossrefPubMedGoogle Scholar
  • 7 Buhmann-Kirchhoff S, Lang R, Kirchhoff C. et al. Functional cine MR imaging for the detection and mapping of intraabdominal adhesions: method and surgical correlation. Eur Radiol 2008; 18 (06) 1215-1223
    CrossrefPubMedGoogle Scholar
  • 8 Spens K, Bird L, Bright P. Transabdominal ultrasound: can it be used to detect and quantify adhesions/reported pain, following caesarean section?. J Bodyw Mov Ther 2018; 22 (03) 733-740
    CrossrefPubMedGoogle Scholar
  • 9 Dehghani Firoozabadi MM, Alibakhshi A, Alaeen H, Zand S, Nazemian R, Rahmani M. Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: a double-blinded cohort study. Ann Med Surg (Lond) 2018; 36: 79-82
    CrossrefPubMedGoogle Scholar
  • 10 Tan HL, Shankar KR, Ade-Ajayi N. et al. Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions in children. J Pediatr Surg 2003; 38 (05) 714-716
    CrossrefPubMedGoogle Scholar
  • 11 Smereczyński A, Starzyńska T, Kołaczyk K. et al. Intra-abdominal adhesions in ultrasound. Part II: the morphology of changes. J Ultrason 2013; 13 (52) 93-103
    CrossrefPubMedGoogle Scholar
  • 12 Deogracias JMC, Almonte JR. Postoperative adhesions after abdominal surgery in children: a pilot study in the Philippines. World J Pediatr Surg 2019; 2 (02) e000049
    CrossrefPubMedGoogle Scholar
  • 13 Bittinger F, Schepp C, Brochhausen C. et al. Remodeling of peritoneal-like structures by mesothelial cells: its role in peritoneal healing. J Surg Res 1999; 82 (01) 28-33
    CrossrefPubMedGoogle Scholar
  • 14 Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 2001; 18 (04) 260-273
    CrossrefPubMedGoogle Scholar
  • 15 Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl 1997; (577) 5-9
    PubMedGoogle Scholar
  • 16 Catena F, Di Saverio S, Coccolini F. et al. Adhesive small bowel adhesions obstruction: evolutions in diagnosis, management and prevention. World J Gastrointest Surg 2016; 8 (03) 222-231
    CrossrefPubMedGoogle Scholar
  • 17 Sigel B, Golub RM, Loiacono LA. et al. Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc 1991; 5 (04) 161-165
    CrossrefPubMedGoogle Scholar
  • 18 Smereczyński A, Starzyńska T, Kołaczyk K. et al. Intra-abdominal adhesions in ultrasound. Part I: the visceroperitoneal bordeline, anatomy and the method of examination. J Ultrason 2012; 12 (51) 472-478
    CrossrefPubMedGoogle Scholar
  • 19 Kolecki RV, Golub RM, Sigel B. et al. Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surg Endosc 1994; 8 (08) 871-874
    CrossrefPubMedGoogle Scholar
  • 20 Kodama I, Loiacono LA, Sigel B. et al. Ultrasonic detection of viscera slide as an indicator of abdominal wall adhesions. J Clin Ultrasound 1992; 20 (06) 375-380
    CrossrefPubMedGoogle Scholar
  • 21 Larciprete G, Valli E, Meloni P. et al. Ultrasound detection of the “sliding viscera” sign promotes safer laparoscopy. J Minim Invasive Gynecol 2009; 16 (04) 445-449
    CrossrefPubMedGoogle Scholar
  • 22 Caprini JA, Arcelus JA, Swanson J. et al. The ultrasonic localization of abdominal wall adhesions. Surg Endosc 1995; 9 (03) 283-285
    CrossrefPubMedGoogle Scholar
  • 23 Kothari SN, Fundell LJ, Lambert PJ, Mathiason MA. Use of transabdominal ultrasound to identify intraabdominal adhesions prior to laparoscopy: a prospective blinded study. Am J Surg 2006; 192 (06) 843-847
    CrossrefPubMedGoogle Scholar
  • 24 Wani AM, Rastogi R, Pratap V, Joon P, Gupta Y. Role of ultrasonography (USG) in evaluation of pericholecystic adhesions in gallstone disease (GSD). Ann Int Med Dental Res 2017; 3 (04) 28
    PubMedGoogle Scholar
  • 25 Mutsaers SE. Mesothelial cells: their structure, function and role in serosal repair. Respirology 2002; 7 (03) 171-191
    CrossrefPubMedGoogle Scholar
  • 26 DiZerega GS. Peritoneum, peritoneal healing, and adhesion formation. In: Peritoneal Surgery. Springer; 2000: 3-37
    Google Scholar
  • 27 Law N, Ellis H. Adhesion formation and peritoneal healing on prosthetic materials. Clin Mater 1988; 3 (02) 95-101
    CrossrefPubMedGoogle Scholar
  • 28 diZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 2001; 7 (06) 547-555
    CrossrefPubMedGoogle Scholar