Skip to main content

Advertisement

SpringerLink
Log in

Cine-MRI detection of intraabdominal adhesions: correlation with intraoperative findings in 89 consecutive cases

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate the accuracy of functional cine-MRI in detecting abdominal adhesions.

Methods

For this study, 89 consecutive patients with adhesion-related complaints after previous abdominal surgery underwent preoperative workup including cine-MRI in transverse and sagittal orientations for a dynamic examination of an induced visceral slide. An abdominal map consisting of nine segments was created to document the location and extent of the adhesion. Cine-MRI and intraoperative findings were correlated.

Results

A total of 59 laparotomies and 30 laparoscopies were performed. Four cases required open surgery due to severe adhesions. The use of cine-MRI scan for the detection of adhesions showed an overall accuracy of 90%, a sensitivity of 93%, and a positive predictive value of 96%. The stronger the adhesions, the more accurate the scan findings. Of 44 patients with second-degree MRI scan findings, 50% had second-degree intraoperative findings. Of 35 patients with third- and fourth-degree adhesions on MRI scans, 74% had exactly the same intraabdominal findings at surgery. The MRI scan showed adhesions located in the small intestines (75%), large intestines (35%), abdominal cavity (42%), and reproductive organs (32%). Intraoperatively, adhesions were found in the small intestines (70%), large intestines (40%), abdominal cavity (42%), and reproductive organs (28%).

Conclusions

Cine-MRI provides valid preoperative information with respect to extent, location, and strength of intraabdominal adhesions. Cine-MRI is a good alternative for diagnosing abdominal adhesions because objective findings of the scan and intraoperative findings correlate very well with each other.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Menzies D, Ellis H (1990) Intestinal obstruction from adhesions: how big is the problem? Ann R Coll Surg Engl 72:60–63

    PubMed  CAS  Google Scholar 

  2. Levrant SG, Bieber EJ, Barnes RB (1997) Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc 4:353–356

    Article  PubMed  CAS  Google Scholar 

  3. Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW (1993) The operative aetiology and types of adhesions causing small bowel obstruction. Aust N Z J Surg 63:848–852

    Article  PubMed  CAS  Google Scholar 

  4. Ellis H (1998) The magnitude of adhesion-related problems. Ann Chir Gynaecol 87:9–11

    PubMed  CAS  Google Scholar 

  5. diZerega GS (1997) Biochemical events in peritoneal tissue repair. Eur J Surg Suppl 577:10–16

    PubMed  Google Scholar 

  6. Hershlag A, Diamond MP, DeCherney AH (1991) Adhesiolysis. Clin Obstet Gynaecol 34:395–402

    Article  CAS  Google Scholar 

  7. Mishell DR, Davajan V (1991) Evaluation of the infertile couple. In: Mishell DR, Davajan V, Lobo RA (eds) Infertility contraception and reproductive endocrinology. 3rd ed. Blackwell Scientific Publications Inc., Oxford, MA, chap 26

    Google Scholar 

  8. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, MCGuire A, Lower AM, Hawthorn RJ, O´Brien F, Buchan S, Crowe AM (1999) Adhesion-related hospital readmissions after abdominal pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480

    Article  PubMed  CAS  Google Scholar 

  9. Lower AM, Hawthorn RJS, Ellis H, O’Brien F, Buchan S, Crowe AM (2000) The impact of adhesions on hospital readmissions over ten years after 8,849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. Br J Obstet Gynaecol 107:855–862

    CAS  Google Scholar 

  10. Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM (2001) Postoperative adhesions: ten-year follow-up of 12.584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44:822–830

    Article  PubMed  CAS  Google Scholar 

  11. Sigel B, Golub RM, Loicono LA (1991) Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc 5:161–165

    Article  PubMed  CAS  Google Scholar 

  12. Uberoi R, D’Costa H, Brown C, Dubbins P (1995) Visceral slide for intraperitoneal adhesions? a prospective study in 48 patients with surgical correlation. J Clin Ultrasound 23:363–366

    Article  PubMed  CAS  Google Scholar 

  13. Kodama I, Loiacono LA, Sigel B, Machi J, Golub RM (1992) Ultrasonic detection of viscera slide as an indicator of abdominal wall adhesions. J Clin Ultrasound 20:375–380

    Article  PubMed  CAS  Google Scholar 

  14. Steitz HO, Meyer G, Schildberg FW (1997) Ultrasonography of adhesions prior to laparoscopic procedures after previous abdominal operations. In: Farthmann EH, Meyer C, Richter HA (eds) Current aspects of laparoscopic colorectal surgery. Springer, New York NY pp 210–216

    Google Scholar 

  15. Steitz HO, Lang RA, Meimarakis G, Schildberg FW (2003) Validity of sonographic evaluation of adhesions. Chir praxis 61:579–584

    Google Scholar 

  16. Freys SM, Fuchs KH, Heimbucher J, Thiede A (1994) Laparoscopic adhesiolysis. Surg Endosc 8:1202–1207

    Article  PubMed  CAS  Google Scholar 

  17. Lienemann A, Sprenger D, Steitz HO, Korell M, Reiser MF (2000) Detection and mapping of intraabdominal adhesions by using functional cine MR Imaging: preliminary results. Radiology 217:421–425

    PubMed  CAS  Google Scholar 

  18. Zühlke HV, Lorenz EM, Straub EM, Savvas V (1990) Pathophysiologie und Klassifikation von Adhäsionen. Langenbeck’s Arch Chir Suppl II Verh Dtsch Ges Chir 345:1009–1016

    Google Scholar 

  19. Ivarson ML, Holmdahl L, Franzen G, Risberg B (1997) Cost of bowel obstruction resulting from adhesions. Eur J Surg 163:679–684

    Google Scholar 

  20. Ray NF Denton WG, Thamer M, Henderson SC, Perry S (1998) Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994; J Am Coll Surg 186:1–9

    Google Scholar 

  21. Kössi JA, Salminen PT, Rantala A, Laato MK (2003) Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions. Br J Surg 90:1441–1444

    Article  PubMed  Google Scholar 

  22. Kössi JA, Salminen PT, Laato MK (2004) Surgical workload and cost of postoperative adhesion-related intestinal obstruction: importance of previous surgery. World J Surg 28:666–670

    Article  PubMed  Google Scholar 

  23. Zondervan K, Barlow DH (2000) Epidemiology of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol 14:403–414

    Article  PubMed  CAS  Google Scholar 

  24. Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM (2001) Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44:822–830

    Article  PubMed  CAS  Google Scholar 

  25. Sunderland G (2003) SCAR-2: the risk of adhesions following colorectal surgery. EACP, Sitges

    Google Scholar 

  26. Lower A, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD, Crowe AM (2003) Adhesion-related readmissions following gynaecological laparoscopy or gynaecological laparotomy in Scotland: an epidemiological study of 24,046 patients. ESHRE, Madrid

    Google Scholar 

  27. Coleman MG, Mc Lain AD, Moran BJ (2000) Impact of previous surgery on time taken for incision and division of adhesions during laparotomy. Dis Colon Rectum 43:1297–1299

    Article  PubMed  CAS  Google Scholar 

  28. Van der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Goor van H (2000) Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 87:467–471

    Article  Google Scholar 

  29. Diamond MP, Freeman ML (2001) Clinical implications of postsurgical adhesions. Hum Reprod Update 7:567–576

    Article  PubMed  CAS  Google Scholar 

  30. Brill AI, Nezhat F, Nezhat CH, Nezhat C (1995) The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstet Gynecol 85:269–272

    Article  PubMed  CAS  Google Scholar 

  31. English J, Ford J, Giannopoulos T (2004) Long-term follow-up of pain and quality-of-life scores after laparoscopic adhesiolysis. Gynaecol Surg 3:175–177

    Google Scholar 

  32. Makanjuola D (1998) Computed tomography compared with small bowel enema in clinically equivocal intestinal obstruction. Clin Radiol 53:203–208

    Article  PubMed  CAS  Google Scholar 

  33. Ha KH, Kim JS, Lee MS (1997) Differentiation of simple and strangulated small bowel obstructions usefulness of CT criteria. Radiology 204:507–512

    PubMed  CAS  Google Scholar 

  34. Maglinte DD, Gage SN, Harmon BH (1993) Obstruction of the small intestine accuracy and role of CT in diagnosis. Radiology 188:61–64

    PubMed  CAS  Google Scholar 

  35. Herrmann KA, Zech CJ, Michaely HJ, Seiderer J, Ochsenkühn T, Reiser MF, Schoenberg SO (2005) Comprehensive magnetic resonance imaging of the small and large bowel using intraluminal dual contrast technique with iron oxide solution and water in magnetic resonance enteroclysis. Invest Radiol 40:621–629

    Article  PubMed  Google Scholar 

  36. Borten M (1986) Laparoscopic complications. BC Decker, Toronto pp 285–295

    Google Scholar 

  37. Ellis H (1997) The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl 577:5–9

    PubMed  Google Scholar 

  38. Swank DJ, Swank-Bordewijk SC, Hop WC, van Erp WF, Janssen IM, Bonjer HJ, Jeekel J (2003) Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial. Lancet 361:1247–1251

    Article  PubMed  CAS  Google Scholar 

  39. Luijendijk RW, de Lange DC, Wauters CC (1996) Foreign material in postoperative adhesions. Ann Surg 223:242–248

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, D–81377, Munich, Germany

    Reinhold A. Lang, Alexander Hopman, Heinrich-Otto Steitz, Karl-Walter Jauch & Thomas P. Hüttl

  2. Department of Clinical Radiology, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, D–81377, Munich, Germany

    Sonja Buhmann, Andreas Lienemann & Maximilian F. Reiser

Authors
  1. Reinhold A. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonja Buhmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Hopman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heinrich-Otto Steitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Lienemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maximilian F. Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karl-Walter Jauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas P. Hüttl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reinhold A. Lang.

Additional information

Lang and Buhmann contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lang, R.A., Buhmann, S., Hopman, A. et al. Cine-MRI detection of intraabdominal adhesions: correlation with intraoperative findings in 89 consecutive cases. Surg Endosc 22, 2455–2461 (2008). https://doi.org/10.1007/s00464-008-9763-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9763-9

Keywords

Search

Navigation