The value of ultrasound sliding sign technique in predicting adhesion-related complications: The point of view of the gynecologist and the anesthesiologist

• Published in: Saudi journal of anaesthesia 2017-04, Vol.11 (2), p.250-252
• Main Authors: Ayachi, Amira, Jendoubi, Ali, Mkaouer, Lassaad, Mourali, Mechaal
• Format: Article
• Language: English
• Subjects: Abdomen; Laparoscopy; Letters to Editor; Medical personnel; Pain; Surgeons; Surgery; Ultrasonic imaging
• ISSN: 1658-354X; 0975-3125
• DOI: 10.4103/1658-354X.203053

[1] Adhesion-related complications comprise various clinical entities including small-bowel obstruction, female infertility, difficulties at reoperation, and chronic pelvic pain. {Figure 1} Adhesions in the vesicouterine pouch were diagnosed if the urinary bladder could not be separated from the anterior aspect of the lower uterine segment, and there was evidence of dense hyperechoic tissue in the vesicouterine pouch [Figure 1]a. Ovarian adhesions were diagnosed when the ovaries could not be mobilized at all by gentle pressure with the vaginal probe and abdominal pressure using the examiner's free hand [Figure 1]b. Adhesions in the POD were diagnosed by the absence of sliding between the uterus and the rectosigmoid colon and by the presence of thick, hyperechoic tissue in the rectovaginal septum [Figure 1]c. Adhesions between the uterus and the anterior abdominal wall were diagnosed if there were no loops of small bowel between the uterus and the anterior abdominal wall. The preoperative diagnosis of pelvic adhesions offers several important advantages: (1) information of the obstetricians about the presence of extensive adhesions before the operation in women planning further pregnancies, (2) reduction of risk of laparoscopic trocar complications (vascular, bowel, urological, and uterine injuries) by the choice of safe laparoscopic entry technique, and (3) exploring the relationship between adhesions and chronic pelvic pain and the effectiveness of adhesiolysis in pain control.