Preoperative ultrasound to predict infraumbilical adhesions: A study of diagnostic accuracy

The purpose of this study was to determine the test characteristics of preoperative abdominal ultrasound in predicting infraumbilical adhesions in women. This was a diagnostic test study of 60 women at risk for intra-abdominal adhesions undergoing laparoscopy or vertical laparotomy. Participants underwent periumbilical sonographic measurement of visceral slide (longitudinal movement of the viscera during a cycle of respiration). Prevalence of infraumbilical bowel adhesions was 12%. A visceral slide threshold <1 cm to predict adhesions had sensitivity = 86%, specificity = 91%, positive predictive value = 55%, and negative predictive value = 98%. On stratifying visceral slide (<0.8 cm, ≥0.8 and <1 cm, and ≥1 cm), the likelihood ratios for detecting adhesions were 15.1, 5.0, and 0.2, respectively. Measuring visceral slide improves preoperative prediction of both presence and absence of bowel adhesions in patients with previous abdominal operations or infection; this technique may assist in avoiding iatrogenic bowel injury.