Haouari Mohamed Amine, Boulay-Coletta Isabelle, Khatri Gaurav, Touloupas Caroline, Anglaret Sophie, Tardivel Anne-Marie, Beranger-Gibert Sophie, Silvera Stephane, Loriau Jerome, Zins Marc
From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.).
Radiographics. 2023 Feb;43(2):e220137. doi: 10.1148/rg.220137.
Sacrocolpopexy and rectopexy are commonly used surgical options for treatment of patients with pelvic organ and rectal prolapse, respectively. These procedures involve surgical fixation of the vaginal vault or the rectum to the sacral promontory with mesh material and can be performed independently of each other or in a combined fashion and by using an open abdominal approach or laparoscopy with or without robotic assistance. Radiologists can be particularly helpful in cases where patients' surgical histories are unclear by identifying normal sacrocolpopexy or rectopexy mesh material and any associated complications. Acute complications such as bleeding or urinary tract injury or stricture are generally evaluated with CT. More chronic complications such as mesh extrusion or exposure with or without fistulization to surrounding structures are generally evaluated with MRI. Other complications can have a variable time of onset after surgery. Patients with suspected bowel obstruction are generally evaluated with CT. Those with suspected infection, abscess formation, and discitis or osteomyelitis may be evaluated with MRI, although CT evaluation may be appropriate in certain scenarios. The authors review the sacrocolpopexy and rectopexy surgical techniques, discuss appropriate imaging protocols for evaluation of patients with suspected complications, and illustrate the normal appearance and common complications of these procedures. RSNA, 2023 Quiz questions for this article are available in the supplemental material.
骶骨阴道固定术和直肠固定术分别是治疗盆腔器官脱垂和直肠脱垂患者常用的手术方式。这些手术通过网状材料将阴道穹窿或直肠手术固定至骶骨岬，可单独进行，也可联合进行，可采用开放腹部入路或腹腔镜手术，有无机器人辅助均可。在患者手术史不明的情况下，放射科医生通过识别正常的骶骨阴道固定术或直肠固定术网状材料及任何相关并发症，可能会有很大帮助。诸如出血、尿路损伤或狭窄等急性并发症一般通过CT评估。诸如网状物挤出或暴露伴或不伴有与周围结构形成瘘管等更慢性的并发症一般通过MRI评估。其他并发症在术后的发病时间可能各不相同。疑似肠梗阻的患者一般通过CT评估。疑似感染、脓肿形成、椎间盘炎或骨髓炎的患者可能通过MRI评估，不过在某些情况下CT评估可能也合适。作者回顾了骶骨阴道固定术和直肠固定术的手术技术，讨论了评估疑似并发症患者的合适影像学方案，并阐述了这些手术的正常表现和常见并发症。RSNA，2023 本文的问答题目见补充材料。
