The Sonographic Sliding Sign: can it predict the need for open as opposed to minimally invasive surgery, a case report

Abstract: The “sliding sign” seen on transvaginal ultrasound (TVS) was originally described to pre-operatively identify adhesions in the pelvis. The absence of freely moving intestine in a whirlwind pattern is consistent with a “negative” sliding sign and increased risk of adhesions. We began using it in pregnant patients with previous cesarean section to see if this information could help alert obstetricians to the presence of dense adhesions to the myometrium, and therefore, guide better management of these patients during child birth. We also theorized that a search for a “sliding sign” trans-abdominally could help guide general surgeons enter the abdomen in patients who had previous abdominal surgery. A patient with a history of previous hysterectomy and oophorectomy who subsequently required colectomy underwent sonographic evaluation for the sliding sign and the absence of the “sliding sign” changed the scheduling of the operative approach from a laparoscopic right colectomy to an open approach. We believe that ultrasonographic evaluation for the “sliding sign” should become standard for all patients with a previous history of abdominal surgery who are being considered for a minimally invasive approach. As ultrasonographic robes with bluetooth capabilities that interface with smart phones become more affordable, it is felt that ultrasonographic examinations could become part of the standard physical exam done by abdominal surgeons.