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Abdominal adhesions

Abdominal adhesions are bands of scar tissue (fibrous band or fibrous fatty tissue), most often occurring as a complication related to prior abdominal surgery. They interconnect loops of bowel or stick to the parietal peritoneum, mainly the abdominal wall and the sub-peritoneal organs.

Patients with a history of intra-abdominal inflammatory disease not treated with surgery, multiple abdominal operations or previous postoperative intraabdominal complications are most likely to experience adhesion formation.

Radiographic features

A non-invasive tool for use in the diagnosis of adhesions is desirable, as the widely used laparoscopic exploration itself may result in the formation of adhesions. The detection of intra-abdominal adhesions is based on indirect signs or abnormal visceral slide.

CT

Computed tomography (CT) has proved to be a valuable diagnostic modality in the detection of advanced adhesion-related problems such as a bowel obstruction or bowel ischaemia. In the absence of concomitant diseases, an abrupt transition from dilated to collapsed bowel segments may be the only hint of the presence of adhesions that can be depicted on CT scans.

Fluoroscopy

Enteroclysis studies are advocated in patients with equivocal clinical symptoms or negative findings at CT.

Indirect signs include

  • hyperperistalsis
  • distortion of folds with luminal narrowing
  • kinking of an entire loop

Direct signs include

  • visible crossing bands
  • a missing separation of adjacent loops with external manual compression

Therefore, this procedure can be used to more accurately identify the location and the cause of the obstruction.

See also

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