Pediatric Abdominal Adhesions

  • Etiology: Bands of scar tissue occurring as a complication of previous abdominal surgery compress the lumen of small bowel
  • Imaging AXR: Small bowel obstruction
  • Imaging Small bowel follow through: Abrupt small bowel luminal narrowing with dilation of the bowel proximal to the adhesion
  • DDX: Ileus – diffusely dilated loops of small bowel and large bowel throughout the abdomen
  • Complications: Partial or complete small bowel obstruction
  • Treatment: May respond to bowel decompression and watchful waiting otherwise surgery is required to lyse the adhesion(s)
  • Clinical:

Radiology Cases of Abdominal Adhesions

Radiology Cases of Abdominal Adhesions Causing Small Bowel Obstruction

SBFT of small bowel obstruction due to abdominal adhesions
AXR supine (left) shows several dilated loops of bowel in the left upper quadrant. Upper GI and small bowel follow through delayed image (right) shows contrast filling several dilated loops of jejunum with no contrast passing distally into the colon.
AXR and upper GI and small bowel followthrough of small bowel obstruction due to adhesions
AXR supine (left) shows multiple dilated loops of small bowel and a paucity of gas in the colon. Image from an upper GI and small bowel follow through exam the next day (right) shows interval increasing dilation of the loops of small bowel. Contrast never reached the colon.

Radiology Cases of Abdominal Adhesions Causing Closed Loop Small Bowel Obstruction

AXR of small bowel obstruction due to abdominal adhesions
AXR supine (left) shows multiple dilated loops of small bowel that have a stacked appearance. AXR upright (right) shows multiple air fluid levels within those loops of small bowel.

Surgery Cases of Abdominal Adhesions

Surgical image of small bowel obstruction due to abdominal adhesions
Surgical image shows dilated and congested loops of small intestine in the upper right corner and normal sized decompressed loops of small bowel adjacent to them. A volvulus was noted at the level of the terminal ileum, caused by adhesions from the cecum to the small bowel, forming a closed loop obstruction that was causing bowel wall congestion.