Visceral slide for intraperitoneal adhesions? A prospective study in 48 patients with surgical correlation.

Bowel perforation in patients undergoing laparoscopic surgery is an uncommon but serious complication. Bowel adherent to the anterior abdominal wall due to adhesions is considered a particular risk. It has been suggested that transabdominal ultrasound can reliably predict the presence of intraperitoneal adhesions. Normal bowel excursions (visceral slide) in 15 volunteers with no history of surgery or peritonitis and in 48 patients undergoing abdominal surgery were evaluated. Visceral slide during spontaneous respiration (SRSL) with manual compression (MCSL) and exaggerated respiration (ESL) was assessed in all 4 quadrants. Adhesions were found in 43 quadrants (12 in the RUQ, 6 in the LUQ, 14 in the RIF, and 11 in the LIF) in 21 patients at surgery. Reduced SRSL detected fibrous adhesions in 6 of 15 quadrants, but only 3 of 28 fibrinous adhesions, with an overall sensitivity of 21%, specificity of 94%, and accuracy of 76%. MCSL detected 9 of 15 fibrous and 9 of 28 fibrinous adhesions, with an overall sensitivity of 42%, specificity of 73.5%, and accuracy of 62%. ESL detected 6 of 15 fibrous and 3 of 28 fibrinous adhesions, with an overall sensitivity of 20%, specificity of 76%, and accuracy of 63%. Preliminary results suggest that ultrasound can detect adhesions preoperatively, but the overall sensitivity is poor and the number of false-positives and false-negatives make it unreliable for routine use.