• Fibrosis appears hypointense on an ADC map and should not be mistaken for tumour. • Susceptibility artefacts on rectal DWI are an important potential pitfall. • T2 shine-through on rectal DWI is an important potential pitfall. • These pitfalls are useful to teach non-experts how to interpret rectal DWI.

ObjectivesThe objectives of this review are (1) to become acquainted with the long-term complications of surgery of the gastrointestinal tract, and (2) to appreciate the appropriate use of imaging in the assessment of long-term complications.BackgroundGastrointestinal tract surgery comprises a group of procedures performed for a variety of both benign and malignant diseases. In the late postoperative setting, adhesions and internal hernias are the most important complications. and they can be further complicated by volvulus and ischemia. At present, computed tomography (CT) is the workhorse for evaluating late postoperative complications. Accurate imaging assessment of patients is essential for adequate treatment planning.Imaging findings or procedure detailsIn this pictorial essay we will review the most frequent long-term complications after gastrointestinal surgery, including adhesions, afferent loop syndrome, closed-loop obstruction, strangulated obstruction, internal hernias, external hernias, anastomotic strictures and disease recurrence. Examples will be depicted using iconography from the authors’ imaging department.ConclusionsKnowledge of the most frequent complications after gastrointestinal surgery in the late postoperative period is of paramount importance for every radiologist, so that potentially life-threatening situations can be promptly diagnosed and adequate therapy can be planned.Teaching points• Long-term postoperative complications of gastrointestinal tract surgery can be divided intoprocedure-relatedanddisease-relatedcategories.• The most commonprocedure-relatedcomplications are internal hernias and adhesions.• The most frequentdisease-relatedcomplications are mainly associated with neoplastic or inflammatory recurrence.• Computed tomography is the most useful examination when such complications are suspected.

ObjectivesTo review the most common disorders depicted with conventional videodefecography, and to compare the defecographic abnormalities between symptomatic patients according to their gender and age.MethodsConventional videodefecography studies of 300 patients (24 men, 266 women; mean age – 57.7) performed in a 32-month period were reviewed for the following parameters: anorectal angle, movement of the pelvic floor, intussusceptions, incontinence and rectocele. The results were analyzed using the chi-square test.ResultsNormal findings were observed in 16.7% men and 7.5% women. In women, the most frequent pathological findings were rectocele (62%), descending perineum syndrome (42.8%), intussusceptions (33.8%), incontinence (10.5%), dyskinetic puborectalis syndrome (9.4%) and rectal prolapse (4.5%); in men the most frequent pathology was the dyskinetic puborectalis syndrome (37.5%). This syndrome is more likely in men than in women (p = 0.01; OR 5.78); descending perineum syndrome (p = 0.027; OR 2.8) is more likely to occur in women.Women with perineal descent younger than 50 years frequently present an increased descent during evacuation (81.8%), while those older than 50 years already have a low pelvic floor during rest (60.3%) (p < 0.001; OR 6.8), with little change in evacuation.ConclusionVideodefecographic findings vary with age and gender.

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Editor:This report was granted exemption from institutional review board approval. The authors report a case of endovascular recanalization and stent placement in the right hepatic vein (HV) by using a collateral loop-guided approach through a caudate-lobe patent accessory HV.A 9-year-old boy presented with a 2-month history of abdominal distension, left thigh pain, and claudication. Blood tests revealed erithrocytosis, γ-glutamyl transpeptidase level of 143 U/L, and lactate level of 2,30 mmol/L. Coagulation, thrombophilia studies, and copper levels were normal. Autoantibody screens were negative, and autoimmune lymphoproliferative syndrome was excluded by flow cytometry. Genetic analysis showed a nonspecific JAK2 gene polymorphism.Doppler ultrasound (US) demonstrated narrowed HVs with decreased flow (10 cm/s), and thrombosis of the confluence of the right, middle, and left HVs (Fig 1). A tortuous caudate lobe vein was identified. The portal vein had antegrade flow with normal velocity (33 cm/s). The hepatic artery had normal resistive indices. Hepatomegaly (liver length at the midclavicular line of 15 cm) and ascites were noted. Computed tomographic (CT) angiography confirmed the HV obstruction and demonstrated caudate lobe hypertrophy with retrohepatic vena cava compression (3 mm). The caudatelobe accessory HV draining into the inferior vena cava (IVC) was identified (Fig 2).The patient was referred to our institution for angiographic evaluation and, if possible, retrograde recanalization of the HVs. The venography and endovascular treatment were performed through a right transjugular approach. A 6-F, 11-cm-long sheath introducer (Boston Scientific, Natick, Massachusetts) was inserted into the right jugular vein, through which a 65-cm-long, 5-F multipurpose 0.038-inch catheter (Cordis, Warren, New Jersey) was advanced into the abdominal IVC. It was impossible to selectively cannulate the main HVs because of the confluence obstruction. The accessory HV draining the caudate lobe directly into the IVC was cannulated. A venous shunt between the accessory caudate lobe vein and the right HV was found. A roadmap image of this shunt was obtained (Fig 3). A 180-cm-long, 0.035-inch nitinol guide wire (Terumo, Tokyo, Japan) was advanced through the shunt into the right HV. Venography at this time revealed a 4-cm obstruction of the right HV. It was possible to cross the obstructing clot and reach the IVC with the Terumo guide wire. The 6-F introducer was replaced by an 11-cm-long, 8-F sheath introducer (Boston Scientific), which allowed a loop fashioned from a 300-cm-long, 0.014-inch Cougar LS Nitinol guide wire (Meditronic, Figure 1. US scan shows echoic material (between calipers) at the confluence of the left and middle HVs, suggestive of obstructing clot. (Available in color online at www.jvir.org.) Figure 2. Postcontrast coronal CT image shows unenhacing caudate-lobe HV communicating with the unopacified main HV through an intrahepatic collateral vessel (arrows). Note the presence of ascites (asterisk).None of the au...