The puckered panniculus--a sign of previous surgery

On abdominal radiographs, the fatty panniculus, if present, has two possible configurations: firstly, a smooth, uniformly convex bow which is the normal appearance; or secondly, a bow with a central indentation (broken bow). This latter is a useful radiographic sign of previous lower abdominal surgery. The central indentation is created by tissue tethering around the laparotomy scar.