Surgical Endoscopy

, Volume 24, Issue 11, pp 2681–2686

Noninvasive detection and mapping of intraabdominal adhesions: a review of the current literature

  • Nellie Bering Zinther
  • Jens Fedder
  • Hans Friis-Andersen



Adhesions are a well-known and very common complication to surgery. Their extent and severity varies according to type and number of surgeries, use of intraabdominal mesh, and presence of peritonitis. Adhesions cause increased morbidity and mortality, with subsequent socioeconomic consequences. This review aimed to identify existing literature on noninvasive radiologic techniques for identification of intraabdominal adhesions.


A structured literature search of medical databases was conducted. English literature published until September 2009 and relevant references were included and assessed.


The search identified transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (cine MRI) as relevant tools matching the search criteria. In all, 12 publications concerning TAU and 4 publications concerning cine MRI were identified. All but one of these publications had the methodologic limitation of not being blinded, which influenced the final sensitivity, specificity, and accuracy.


Both TAU and cine MRI seem able to identify intraabdominal adhesions using visceral slide with accuracy of 76% to 92%. Unfortunately, the studies are biased by being nonblinded. Accordingly, a need exists for a systematic well-conducted double-blinded comparative study to validate these radiologic techniques.


Abdomen Adhesion Cine MRI Detection Ultrasonography Visceral slide 


  1. 1.
    Levrant SG, Bieber EJ, Barnes RB (1997) Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc 4:353–356CrossRefPubMedGoogle Scholar
  2. 2.
    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 and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480CrossRefPubMedGoogle Scholar
  3. 3.
    Tingstedt B, Isaksson J, Andersson R (2007) Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions. Br J Surg 94:743–748CrossRefPubMedGoogle Scholar
  4. 4.
    van GH (2007) Consequences and complications of peritoneal adhesions. Colorectal Dis 9(Suppl 2):25–34Google Scholar
  5. 5.
    Sasaki M, Kawabe M, Hirai S, Yamada N, Morioka K, Ihaya A, Tanaka K (2005) Preoperative detection of pleural adhesions by chest ultrasonography. Ann Thorac Surg 80:439–442CrossRefPubMedGoogle Scholar
  6. 6.
    Balique JG, Benchetrit S, Bouillot JL, Flament JB, Gouillat C, Jarsaillon P, Lepere M, Mantion G, Arnaud JP, Magne E, Brunetti F (2005) Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia 9:68–74CrossRefPubMedGoogle Scholar
  7. 7.
    Bingener J, Kazantsev GB, Chopra S, Schwesinger WH (2004) Adhesion formation after laparoscopic ventral incisional hernia repair with polypropylene mesh: a study using abdominal ultrasound. JSLS 8:127–131PubMedGoogle Scholar
  8. 8.
    Aube C, Pessaux P, Tuech JJ, du PR, Becker P, Caron C, Arnaud JP (2004) Detection of peritoneal adhesions using ultrasound examination for the evaluation of an innovative intraperitoneal mesh. Surg Endosc 18:131–135CrossRefPubMedGoogle Scholar
  9. 9.
    Arnaud JP, Hennekinne-Mucci S, Pessaux P, Tuech JJ, Aube C (2003) Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia 7:85–88CrossRefPubMedGoogle Scholar
  10. 10.
    Fischer T, Ladurner R, Gangkofer A, Mussack T, Reiser M, Lienemann A (2007) Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results. Eur Radiol 17:3123–3129CrossRefPubMedGoogle Scholar
  11. 11.
    van der Wal JB, Jeekel J (2007) Biology of the peritoneum in normal homeostasis and after surgical trauma. Colorectal Dis 9(Suppl 2):9–13PubMedGoogle Scholar
  12. 12.
    Duron JJ (2007) Postoperative intraperitoneal adhesion pathophysiology. Colorectal Dis 9(Suppl 2):14–24CrossRefPubMedGoogle Scholar
  13. 13.
    Voskerician G, Jin J, Hunter SA, Williams CP, White M, Rosen MJ (2009) Human peritoneal membrane reduces the formation of intra-abdominal adhesions in ventral hernia repair: experimental study in a chronic hernia rat model. J Surg Res 157:108–114CrossRefPubMedGoogle Scholar
  14. 14.
    diZerega GS, Campeau JD (2001) Peritoneal repair and postsurgical adhesion formation. Hum Reprod Update 7:547–555CrossRefPubMedGoogle Scholar
  15. 15.
    Holmdahl L (1997) The role of fibrinolysis in adhesion formation. Eur J Surg Suppl (577):24–31Google Scholar
  16. 16.
    Ellis H (1971) The cause and prevention of postoperative intraperitoneal adhesions. Surg Gynecol Obstet 133:497–511PubMedGoogle Scholar
  17. 17.
    Sigel B, Golub RM, Loiacono LA, Parsons RE, Kodama I, Machi J, Justin J, Sachdeva AK, Zaren HA (1991) Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc 5:161–165CrossRefPubMedGoogle Scholar
  18. 18.
    Borzellino G, De MG, Ricci F (1998) Detection of abdominal adhesions in laparoscopic surgery: a controlled study of 130 cases. Surg Laparosc Endosc 8:273–276CrossRefPubMedGoogle Scholar
  19. 19.
    Caprini JA, Arcelus JA, Swanson J, Coats R, Hoffman K, Brosnan JJ, Blattner S (1995) The ultrasonic localization of abdominal wall adhesions. Surg Endosc 9:283–285PubMedGoogle Scholar
  20. 20.
    Hsu WC, Chang WC, Huang SC, Torng PL, Chang DY, Sheu BC (2006) Visceral sliding technique is useful for detecting abdominal adhesion and preventing laparoscopic surgical complications. Gynecol Obstet Invest 62:75–78CrossRefPubMedGoogle Scholar
  21. 21.
    Kodama I, Loiacono LA, Sigel B, Machi J, Golub RM, Parsons RE, Justin J, Zaren HA, Sachdeva AK (1992) Ultrasonic detection of viscera slide as an indicator of abdominal wall adhesions. J Clin Ultrasound 20:375–380CrossRefPubMedGoogle Scholar
  22. 22.
    Kolecki RV, Golub RM, Sigel B, Machi J, Kitamura H, Hosokawa T, Justin J, Schwartz J, Zaren HA (1994) Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surg Endosc 8:871–874CrossRefPubMedGoogle Scholar
  23. 23.
    Kothari SN, Fundell LJ, Lambert PJ, Mathiason MA (2006) Use of transabdominal ultrasound to identify intraabdominal adhesions prior to laparoscopy: a prospective blinded study. Am J Surg 192:843–847CrossRefPubMedGoogle Scholar
  24. 24.
    Marin G, Bergamo S, Miola E, Caldironi MW, Dagnini G (1987) Prelaparoscopic echography used to detect abdominal adhesions. Endoscopy 19:147–149CrossRefPubMedGoogle Scholar
  25. 25.
    Steitz HO, Meyer G, Schildberg FW (1997) Ultrasonography of adhesions prior to laparoscopic procedures after previous abdominal operations: current aspects of laparoscopic colorectal surgery. Springer, New York, pp 210–216Google Scholar
  26. 26.
    Tan HL, Shankar KR, de-Ajayi N, Guelfand M, Kiely EM, Drake DP, De BR, McHugh K, Smith AJ, Morris L, Gent R (2003) Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions in children. J Pediatr Surg 38:714–716CrossRefPubMedGoogle Scholar
  27. 27.
    Tu FF, Lamvu GM, Hartmann KE, Steege JF (2005) Preoperative ultrasound to predict infraumbilical adhesions: a study of diagnostic accuracy. Am J Obstet Gynecol 192:74–79CrossRefPubMedGoogle Scholar
  28. 28.
    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 23:363–366CrossRefPubMedGoogle Scholar
  29. 29.
    Lienemann A, Sprenger D, Steitz HO, Korell M, Reiser M (2000) Detection and mapping of intraabdominal adhesions by using functional cine MR imaging: preliminary results. Radiology 217:421–425PubMedGoogle Scholar
  30. 30.
    Katayama M, Masui T, Kobayashi S, Ito T, Sakahara H, Nozaki A, Kabasawa H (2001) Evaluation of pelvic adhesions using multiphase and multislice MR imaging with kinematic display. AJR Am J Roentgenol 177:107–110PubMedGoogle Scholar
  31. 31.
    Buhmann-Kirchhoff S, Lang R, Kirchhoff C, Steitz HO, Jauch KW, Reiser M, Lienemann A (2008) Functional cine MR imaging for the detection and mapping of intraabdominal adhesions: method and surgical correlation. Eur Radiol 18:1215–1223CrossRefPubMedGoogle Scholar
  32. 32.
    Lang RA, Buhmann S, Hopman A, Steitz HO, Lienemann A, Reiser MF, Jauch KW, Huttl TP (2008) Cine-MRI detection of intraabdominal adhesions: correlation with intraoperative findings in 89 consecutive cases. Surg Endosc 22:2455–2461CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Nellie Bering Zinther
    • 1
    • 2
  • Jens Fedder
    • 2
  • Hans Friis-Andersen
    • 1
  1. 1.Surgical DepartmentHorsens HospitalHorsensDenmark
  2. 2.Scientific UnitHorsens HospitalHorsensDenmark

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