Imaging diagnostics of abdomen and pelvis complications in female reproductive system malignancies

Female reproductive system malignancies are frequently associated with a high risk of abdominopelvic complications, arising both from the tumor process itself and due to therapeutic interventions, including surgery, radiotherapy, chemotherapy, and immunotherapy. Such complications may profoundly worsen prognosis, impair quality of life, and hinder further treatment. Imaging diagnostics plays a crucial role in their timely detection, providing an opportunity not only to evaluate an extent and distribution of pathology but also to differentiate expected post-therapeutic changes from true complications. This article reviews the most common complications encountered after surgical procedures, such as lymphatic complications, fistulas, and infectious processes, as well as those following pelvic exenteration. Radiation-induced toxic effects are described, including both early and late changes affecting the gastrointestinal tract, urinary system, and musculoskeletal structures. Particular attention is paid to complications associated with chemotherapy and contemporary systemic therapies, including targeted agents and immunotherapy, which may result in hepatobiliary, pancreatic, gastrointestinal, vascular, and skeletal toxicities. Typical radiological manifestations related to such complications are discussed primarily outlining those following computed tomography (CT) and magnetic resonance imaging (MRI) exerting an essential role for early diagnosis, treatment planning, and follow-up. A comprehensive understanding of imaging features for abdominopelvic complications in patients with gynecologic malignancies is required for accurate diagnosis, prevented misinterpretation, and patient care optimization.