Page 25 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, May-August 2009;2(2):30-32
Shailaja Chhetri

Laparoscopy as a Diagnostic Tool in the

Evaluation of Chronic Pelvic Pain in Women

Shailaja Chhetri
Consultant, Obstetrics and Gynecology, 5 Mile Tadong, Gangtok, Sikkim, India

Abstract AIMS AND OBJECTIVES
Chronic pelvic pain is a common and significant disorder of women. The main aim of the study is to assess the various causes of
Often the etiology of chronic pelvic pain is not clear.
Chronic pelvic pain is a common problem and presents a major chronic pelvic pain with the help of laparoscopy as a diagnostic
challenge to health care providers because of its unclear etiology, tool.
complex natural history, and poor response to therapy. Diagnostic
laparoscopy is an important tool in the evaluation of women with chronic MATERIAL AND METHODS
pelvic pain.
Keywords: chronic pelvic pain, laparoscopy, pelvic adhesions, A literature search was performed using Medline, Pubmed
endometriosis, pelvic congestion, fibroids. (National Library of Medicine, Bethesda, MD), search engine
Google, Springerlink and Highwire press (Stanford University
INTRODUCTION Libraries). In the searches of Medline, Google, Springerlink and

Chronic pelvic pain is defined as a noncyclic pelvic pain of Highwire press, the following search terms were used
greater than six months, which is not relieved by nonnarcotic laparoscopy, chronic pelvic pain, pelvic adhesions,

analgesics.Chronic pelvic pain has been found to be one of the endometriosis, pelvic congestion and fibroids. Potentially
most common symptoms attending gynecological outpatient relevant papers were reviewed. Selected papers were further
department in gynecology. Prevalence of chronic pelvic pain screened for references. Criteria for selection of literature were
has been reported as 3.8% in women aged 15-73, which is higher that all were limited to human subjects who were all females, the
than the prevalence of migraine (2.1%) and similar to that of number of cases more than 20.
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bronchial asthma (3.7%) or back pain (4.1%). In primary care COMMENTS
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practices, 39% of women complain of pelvic pain. Chronic
pelvic pain is estimated to account for 10% of all referrals to The causes of chronic pelvic pain maybe somatic or nonsomatic
gynecologists, it is the indication for 12% of all hysterectomies (psychogenic). Somatic causes of chronic pelvic pain in women
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and over 40% of gynecologic laparoscopies. Clearly, pelvic are commonly gynecological and the most common are pelvic
pain is an important issue in the health care of women. Chronic adhesions, endometriosis, pelvic congestions, fibroids,
pelvic pain seem to occur during reproductive years although adenomyosis, ovarian cysts and pelvic inflammatory disease.
some particular enigmatic pain syndromes may occur in young Nongynecological causes include irritable bowel syndrome,
adolescents and other causes may occur after menopause and insterstitial cystitis, diverticulitis and mysofascial pain
in the elderly. symptoms.
Chronic pelvic pain is characterized by six common Laparoscopy, because of its availability and safety, provides
characteristics; duration of six months or longer, incomplete a valuable tool in the evaluation of undiagnosed chronic pelvic
relief by previous treatment, pain out of proportion to tissue pain. It is a simple and often definitive means of establishing
damage, loss of physical function at home or work, vegetative the presence or absence of pelvic pathology without resorting
signs of depression and altered family and social roles. to major abdominal surgery.
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Laparoscopy is a valuable clinical tool in the diagnosis of Marana et al performed laparoscopy in 137 patients with
chronic pelvic pain. It can confirm a clinical impression, establish chronic pelvic pain and abnormal laparoscopic findings were
a definite diagnosis, follow the course of a disease and modify detected in 102 (80%) patients whereas 25 (20%) patients had a
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therapy accordingly. normal laparoscopic examination. Kontoravdis et al 5

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