Abstract:Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.
“…Conversely, air which persists or increases should raise concern for visceral perforation. Following laparoscopic surgery, the amount of expected intraperitoneal free gas is lower compared to AH because insufflated carbon dioxide is rapidly reabsorbed, and subcutaneous emphysema from insufflation in the abdominal wall is sometimes encountered [ 22 – 24 ]. Fig.…”
Section: Early Post-hysterectomy Ctmentioning
confidence: 99%
“…Borrowing from experience with spontaneous acute abdomens, CT effectively triages presence and degree of obstruction, transition point (Fig. 9 ) and possible signs of strangulation [ 22 – 24 ]. Fig.…”
Section: Ct Imaging Of Post-hysterectomy Complicationsmentioning
Indicated to manage a variety of disorders affecting the female genital tract, hysterectomy represents the second most common gynaecological operation after caesarean section. Performed via an open, laparoscopic or vaginal approach, hysterectomy is associated with non-negligible morbidity and occasional mortality. Iatrogenic complications represent a growing concern for gynaecologists and may result in prolonged hospitalisation, need for interventional procedures or repeated surgery, renal impairment and malpractice claims. As a result, radiologists are increasingly requested to investigate patients with suspected complications after hysterectomy. In the vast majority of early postoperative situations, multidetector CT represents the ideal modality to comprehensively visualise the surgically altered pelvic anatomy and to consistently triage the varied spectrum of possible injuries. This pictorial review provides an overview of current indications and surgical techniques, illustrates the expected CT appearances after recent hysterectomy, the clinical and imaging features of specific complications such as lymphoceles, surgical site infections, haemorrhages, urinary tract lesions and fistulas, bowel injury and obstruction. Our aim is to increase radiologists’ familiarity with normal post-hysterectomy findings and with post-surgical complications, which is crucial for an appropriate choice between conservative, interventional and surgical management.Teaching points• Hysterectomy via open, laparoscopic or vaginal route is associated with non-negligible morbidity.
• Multiplanar CT imaging optimally visualises the surgically altered pelvic anatomy.
• Familiarity with early post-hysterectomy CT and expected findings is warranted.
• Complications encompass surgical site infections, haemorrhages, bowel injury and obstruction.
• Urological complications include ureteral leakage, bladder injury, urinomas and urinary fistulas.
“…Conversely, air which persists or increases should raise concern for visceral perforation. Following laparoscopic surgery, the amount of expected intraperitoneal free gas is lower compared to AH because insufflated carbon dioxide is rapidly reabsorbed, and subcutaneous emphysema from insufflation in the abdominal wall is sometimes encountered [ 22 – 24 ]. Fig.…”
Section: Early Post-hysterectomy Ctmentioning
confidence: 99%
“…Borrowing from experience with spontaneous acute abdomens, CT effectively triages presence and degree of obstruction, transition point (Fig. 9 ) and possible signs of strangulation [ 22 – 24 ]. Fig.…”
Section: Ct Imaging Of Post-hysterectomy Complicationsmentioning
Indicated to manage a variety of disorders affecting the female genital tract, hysterectomy represents the second most common gynaecological operation after caesarean section. Performed via an open, laparoscopic or vaginal approach, hysterectomy is associated with non-negligible morbidity and occasional mortality. Iatrogenic complications represent a growing concern for gynaecologists and may result in prolonged hospitalisation, need for interventional procedures or repeated surgery, renal impairment and malpractice claims. As a result, radiologists are increasingly requested to investigate patients with suspected complications after hysterectomy. In the vast majority of early postoperative situations, multidetector CT represents the ideal modality to comprehensively visualise the surgically altered pelvic anatomy and to consistently triage the varied spectrum of possible injuries. This pictorial review provides an overview of current indications and surgical techniques, illustrates the expected CT appearances after recent hysterectomy, the clinical and imaging features of specific complications such as lymphoceles, surgical site infections, haemorrhages, urinary tract lesions and fistulas, bowel injury and obstruction. Our aim is to increase radiologists’ familiarity with normal post-hysterectomy findings and with post-surgical complications, which is crucial for an appropriate choice between conservative, interventional and surgical management.Teaching points• Hysterectomy via open, laparoscopic or vaginal route is associated with non-negligible morbidity.
• Multiplanar CT imaging optimally visualises the surgically altered pelvic anatomy.
• Familiarity with early post-hysterectomy CT and expected findings is warranted.
• Complications encompass surgical site infections, haemorrhages, bowel injury and obstruction.
• Urological complications include ureteral leakage, bladder injury, urinomas and urinary fistulas.
“…[7][8][9] But the critical factor associated with the recovery of NSS such as kidney wound healing was mostly unexplored. Although multidetector CT is applied to diagnose the complications about kidney wound such as hemorrhage and urine leaks, 10,11 the continuous observation of kidney wound in the early postoperative stage of NSS has not been reported, so we aimed at seeking for an image examination method to reflect the process of kidney wound healing.…”
To investigate feasibility, repeatability and usefulness of contrast-enhanced ultrasonography (CEUS) in the assessment of kidney wound recovery after laparoscopic nephronsparing surgery (LNSS) or robot-assisted nephron-sparing surgery (RANSS) and preliminarily research the clinical factors associated with the length of extravasation (LOE). Patients and Methods: From April 2019 to January 2020, 130 patients that underwent LNSS or RANSS in our hospital were included, and 90 patients (90/130) received CEUS examinations each one day from the postoperative day 1. The discovery of the cessation of contrast medium extravasation from the renal wound was the primary endpoint named "ultrasonic healing", and LOE ranged from the day of surgery to "ultrasonic healing". Patient, tumor, perioperative factors and LOE were collected. Univariate analysis and multivariate linear regression analysis were applied for the determination of factors associated with LOE. Results: The average postoperative LOE was 1.76 days (standard deviation, 1.115; 95% confidence interval: 1.52-1.99). Ultrasonic healing within three days was observed in 95.6% patients (86/90). Univariable and multivariable analyses showed that R and A components in R.E.N.A.L. nephrometry score were associated with LOE. Anterior location and R component score of 2 (tumor size>4cm) were related to longer LOE than posterior location and R score of 1 (tumor size<4cm). The incidence of complications in patients with LOE over one day was higher than those with LOE of one day. Conclusion: CEUS was feasible, repeatable and useful in the assessment of kidney wound recovery. Tumor size and location were related to LOE after minimally invasive nephron-sparing surgery (MINSS). Length of stay after MINSS within three days might be relatively safe.
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