Imaging of Complications Following Gynecologic Surgery

Abstract

Despite new nonsurgical treatment methods for gynecologic diseases (eg, endometrial radiofrequency ablation for dysfunctional uterine bleeding, uterine artery embolization for uterine fibroids), surgery continues to be the main treatment modality in this setting. New and improved surgical techniques include laparoscopic hysterectomy, which is performed much more frequently than abdominal hysterectomy because it offers the advantages of speedy postsurgical recovery and a short hospital stay. Nevertheless, a number of early and delayed complications continue to occur following gynecologic surgery. Radiologists with access to multiple imaging modalities play an important role in the diagnosis and management of these postsurgical complications and can assist the surgeon at this critical juncture. Improved computed tomographic and magnetic resonance imaging techniques have made imaging more reliable for early diagnosis. Familiarity with normal postsurgical anatomy, pitfalls in interpretation, and imaging-guided interventional procedures will facilitate the diagnosis and management of complications following gynecologic surgery.

Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings

“…MRI is superior to CT for the diagnosis of uterine dehiscence; it has a higher sensitivity and specificity due to its multiplanar capability and greater soft-tissue contrast (1). MRI, particularly in the sagittal plane, can discriminate between uterine rupture and dehiscence by delineating all uterine wall layers and identifying an intact serosa covering the myometrial gap (10,11,14). On T2-weighted imaging, a normal CS scar will appear as a linear hyperintense focus in the myometrium, whereas a true dehiscence will appear as a hyperintense focus through the full thickness of the endometrium and myometrium, sparing the serosal layer.…”

“…Moreover, a true dehiscence is usually associated with a large hematoma or abscess that can be easily seen on MRI. Contrast-enhanced MRI is useful in confirming the thickness defect (14).…”

Female Pelvis: Genital Organs

“…During intracavitary radiotherapy small pockets of air surrounding the vaginal cylinder applicators present a normal fi nding (Hassouna et al 2014 ). Vaginal edema and thickening of the vaginal stump exhibiting high SI on T2WI is typically seen in the early postoperative period (Paspulati and Dalal 2010 ). Vaginal vault hematoma or hemorrhage occurs most commonly within the fi rst week after surgery (Paspulati and Dalal 2010 ) (Fig.…”

“…Vaginal edema and thickening of the vaginal stump exhibiting high SI on T2WI is typically seen in the early postoperative period (Paspulati and Dalal 2010 ). Vaginal vault hematoma or hemorrhage occurs most commonly within the fi rst week after surgery (Paspulati and Dalal 2010 ) (Fig. 1 ).…”

“…2 ), stricture, or fi stula formations. Bowel obstruction is rather found as delayed complication secondary to adhesions than in the early postoperative period (Paspulati and Dalal 2010 ).…”