Preoperative ultrasonography in the evaluation of abdominal wall adhesions

Background: To detect and document preoperatively the presence of bowel and omental adhesions in the periumbilical region and along the previous abdominal scar using visceral slide scale by ultrasonography, and to compare the ultrasonic findings with intraoperative laparotomy or laparoscopy.Methods: It was a cross-sectional observational study conducted between for 18 months at Guru Teg Bahadur Hospital, Delhi. Patients who had previously undergone abdominal surgery and were subsequently admitted for either laparotomy or laparoscopy (N=100) were selected. All patients underwent ultrasonography for visceral slide evaluation both along the scar and in a radius of 4 cm around the umbilicus. Later, peroperative findings were compared with ultrasonic findings.Results: Mean visceral slide without and with adhesions was 2.39 (±1.21) versus 1.74 (±1.26) cm, correlation being significant (p=0.017) along the scar. While, the mean slide along the scar without and with adhesions in periumbilical region was 2.33 (±1.24) versus 1.07 (±1.07) cm, (p=0.007) on un-paired t-test showing sensitivity=51.6%, specificity=81.15%, positive predictive value=55.2%, and negative predictive value=78.9%. Patients with bowel adhesions (N=3) had restricted visceral slide both in periumblical region and along the scar (1.07 and 0.5 cm respectively).Conclusions: Preoperative ultrasonography using visceral slide is a valuable technique in the detection of abdominal wall adhesions. A slide of ≤1 cm in the periumbilical region strongly suggests bowel adhesions.

Usefulness of Ultrasonography in Diagnosis and Management of Tendon Injuries in Hand

Purpose: Tendon injuries in hand were one of the most frequent injuries caused by trauma. Although consequent tenorrhaphy is frequently conducted, in complete tendon rupture the location of retracted tendon stumps cannot be identified clearly, which causes difficulties in surgical management. Ultrasonography is known to be a fast, accurate, and cost-effective diagnostic method for tendon injury; therefore, the authors studied the usefulness of preoperative ultrasonography in diagnosis and management of tendon injuries in hand.Methods: Among the 34 patients who had hand tendon injuries and visited between January 2017 and March 2018, retrospective studies were conducted on six patients with unidentified tendon stumps. By identifying the location of the tendon injuries and ruptured tendon stumps through preoperative ultrasonography, the operation was conducted under a predetermined surgical plan. The authors compared the ultrasonography results and the surgical findings.Results: For diagnosis of the unidentified tendon injuries and location of ruptured tendon stumps, the ultrasonography results and the surgical findings were matched for all six patients. By prior planning of the operation incision line using the preoperative ultrasonography results, the length of the incision site was minimized without additional incision, and the operation time was shortened.Conclusion: For hand tendon injuries with unidentified tendon stumps, identifying the location of tendon stumps through preoperative ultrasonography is helpful for determining the incision range for the operation. Therefore, preoperative ultrasonography may be useful in the diagnosis and management of tendon injuries in hand.

Management of the Thyroid Gland in Papillary Carcinoma of the Thyroglossal Cyst: A Case Report

Carcinoma arising in a thyroglossal cyst is rare. We present a case of anterior neck swelling diagnosed to be thyroglossal cyst clinically which turns out to be a papillary carcinoma arising in thyroglossal cyst. She underwent sistrunk procedure with total thyroidectomy and diseasefree on follow up evaluation. Even though preoperative ultrasonography had shown thyroid nodule, the final histology did not show malignancy. There is a paucity of clear-cut guidelines in the management of the thyroid gland in a thyroglossal cyst carcinoma. In thyroglossal cyst carcinoma cases, we recommend thyroidectomy only when there is a thyroid nodule with high-risk features.