Evaluation Of Chronic Pelvic Pain Research Articles

8983 Pararectal Schwannoma Causing Pelvic Pain

<h3>Study Objective</h3> To describe a surgical management of a very rare case of rectal schwannoma as cause of chronic pelvic pain and postoperative outcome. <h3>Design</h3> Video Presentation. <h3>Setting</h3> University tertiary care hospital. <h3>Patients or Participants</h3> 41-yo G0P0000 presents for evaluation of chronic pelvic pain for many months. Past medical history: Migraines, Anxiety disorder. Past Surgical History: Laparoscopic Hysterectomy and bilateral salpingectomy followed by right oophorectomy few months later. Physical exam: the cervix and uterus noted to be absent, no other abnormalities were found. <h3>Interventions</h3> Rectal Schwannoma is extremely rare and only 12 cases have been reported, our patient had already underwent total laparoscopic hysterectomy, bilateral salpingectomy and right oophorectomy for pelvic pain without relief, MRI was done and showed para rectal mass, laparoscopic resection of the mass was done. <h3>Measurements and Main Results</h3> At the 2-week postoperative follow up, the patient reported resolution of her painful symptoms. <h3>Conclusion</h3> Chronic pelvic pain is often a challenge to diagnose and to manage given the large number of etiologies, rectal schwannoma is extremely rare but can be the etiology behind pelvic pain, MRI helps with diagnosis and laparoscopic resection is possible with complete pain relief

A Case Report of Neglected Gossypiboma Causing Abdominal Pain for 20 Years Post-Cesarean Section.

Gossypiboma refers to a mass usually made of cotton (e.g., surgical gauze or sponge) that is accidentally left in a patient's body during surgery. We report the case of a 54-year-old multigravida menopausal woman who previously underwent cesarean section to deliver her second child. She was referred to our medical center after a 7 cm right ovarian mass with malignant potential was discovered. A diagnostic laparotomy was performed then confirmed the presence of a 10 cm gossypiboma attached to a metallic ring. This case is an alarming example highlighting the importance of adequate intraoperative counting of gauze and radiologic evaluation of chronic pelvic pain.

The Role of Diagnostic Laparoscopy in Chronic Pelvic Pain

One of the commonest symptomatology in gynecological outpatient clinics is chronic pelvic pain, it accounts for 10% of gynecologist’s general clinics patients. The study aimed to To evaluate the role of laparoscopy in evaluation of CPP, and its correlation with clinical examination and vaginal ultrasound examination. The present prospective study was done in the Department of Obstetrics and Gynecology Salah Al-Deen general hospital in Tikrit city from 1stApril- 31st August 2020. The study sample consists of 30 patients with chronic pelvic pain, according to the ACOG criteria, with a convenient sampling method. The data collection done through: a designed closed and open-ended questionnaire, physical examination, transvaginal ultrasound &amp; laparoscopic examination for the 30 patients for evaluation of chronic pelvic pain. By laparoscopic examination (90%) of patients had positive findings, pelvic examination identified (89%) of them correctly. Those with negative findings in laparoscopy was (10%) of patient, (33.3%) of them were diagnosed as negative by pelvic examination, there were miss diagnosis in (67%) of the negative patient and (11.1%) of positive diagnosed patient, this was a statically significant relation. Sensitivity of TVS was 85%, versus 89% for the pelvic examination. Specificity for TVS, and pelvic examination was (100%), (33%) respectively. Accuracy of the test for TVS, and pelvic examination was (87%), (83%) respectively. Exploratory laparoscopy provides a definitive diagnosis in 90% of women complaining of unexplained CPP. The surgical treatment of these lesions improves painful symptomatology in 70% of women .

Comparative Study of Clinical and Laparoscopic Examination in Evaluation of Chronic Pelvic Pain

Comparative Study of Clinical and Laparoscopic Examination in Evaluation of Chronic Pelvic Pain

Chronic pelvic pain.

As opposed to the satisfying solutions found in the management of acute pain, chronic pelvic pain can be a vexing problem for the patient and physician. Seldom is a single source or cause found, and nearly always the condition is influenced by the broader social and psychological context of the patient. In this article, we discuss the evaluation of chronic pelvic pain, often considering pain as the disease itself, and identify peripheral generators, which gynecologists can address to help reduce their contributions to symptoms.

The Puzzle of Pelvic Pain—A Rehabilitation Framework for Balancing Tissue Dysfunction and Central Sensitization, I

Chronic pelvic pain is associated with physiological, psychological, and social challenges. Using current concepts from pain sciences and evidence-based treatment strategies, physical therapists are ideally positioned to be a critical part of a comprehensive treatment plan for chronic pelvic pain. We propose a framework for the understanding and evaluation of chronic pelvic pain. This framework is grounded in basic and clinical pain sciences and in the biopsychosocial model. The framework integrates the current understanding of local tissue complaints with the wider context of sensitized protective mechanisms within the spinal cord and brain. Treatments address both the local tissue complaints and the central nervous system sensitivity by teaching patients about the biological processes underpinning their pain, graded imagery, and graded exposure.

Use of the Short-Form McGill Pain Questionnaire as a Diagnostic Tool in Women with Chronic Pelvic Pain

Study Objective To estimate the usefulness of the Short-Form McGill Pain Questionnaire (MPQ) pain descriptors in the diagnostic evaluation of chronic pelvic pain. Design Retrospective cohort study (Canadian Task Force classification II-2). Setting University-based center specializing in chronic pelvic pain. Patients Three hundred thirty-one consecutively evaluated women with chronic pelvic pain who had data sufficient for evaluation. Interventions The relationships between MPQ pain descriptors and subsequent diagnoses were evaluated using odds ratios, sensitivity, specificity, and positive and negative predictive values. Measurements and Main Results The most common diagnoses were endometriosis, interstitial cystitis and painful bladder syndrome, and irritable bowel syndrome. Seventy-one percent of the patients had more than one diagnosis. Relative risks for pain descriptors as diagnostic tools for specific diagnoses were most significant, with “cramping” for endometriosis (4.0), “cramping” for interstitial cystitis and painful bladder syndrome (2.0), “sickening” for irritable bowel syndrome (1.5), and “aching” for abdominal myofascial pain syndrome (4.27). Conclusion Several of the MPQ descriptors had high negative predictive values but not high positive predictive values, which suggests that they have diagnostic usefulness in excluding but not predicting pelvic pain–related diagnoses. This was especially the case with cramping as an MPQ descriptor in women with endometriosis. However, overall the MPQ descriptors were not robust as diagnostic tools, which suggests that inclusion of the MPQ descriptors in the evaluation of women with chronic pelvic pain is of limited diagnostic value.

Measuring quality of life in chronic pelvic pain syndrome

The evaluation of health-related quality of life (QoL) in patients with chronic pelvic pain syndrome is a challenging problem owing to the complexity of the underlying diagnoses and the multitude of instruments available. QoL may seem an obvious concept overall, generally encompassing physical functioning, social interactions and psychological wellbeing, but providing quantitative measures can be challenging and involves assurance of both face validity and psychometric statistical robustness. In addition to generic QoL measures, chronic pelvic pain-related disease-specific measures for endometriosis, interstitial cystitis, irritable bowel syndrome and vulvodynia can assist in identification of multiple concurrent diagnoses. This article reviews recent advances in QoL evaluation of chronic pelvic pain, and describes the features of both the generic and disease-specific instruments available to assist clinicians and researchers in evaluating patients and optimizing outcomes.

Laparoscopy as a Diagnostic Tool in the Evaluation of Chronic Pelvic Pain in Women

Chronic pelvic pain is a common and significant disorder of women. Often the etiology of chronic pelvic pain is not clear. Chronic pelvic pain is a common problem and presents a major challenge to health care providers because of its unclear etiology, complex natural history, and poor response to therapy. Diagnostic laparoscopy is an important tool in the evaluation of women with chronic

Diagnosis of Stage I Endometriosis: Comparing Visual Inspection to Histologic Biopsy Specimen

Study Objective To evaluate positive predictive value (PPV) of visual diagnosis at laparoscopy compared with biopsy findings according to severity of endometriosis. Design Retrospective study (Canadian Task Force classification II-2). Setting Academic referral center. Patients Women who underwent laparoscopic biopsies for suspected endometriosis. Interventions A total of 238 biopsy specimens (73 endometriomas and 165 peritoneal implants) were taken from 104 patients undergoing laparoscopy for evaluation of chronic pelvic pain thought to be caused by endometriosis. Measurements and Main Results Accuracy of laparoscopic findings compared with histology-proved endometriosis by severity of disease and location of endometriotic lesions. Overall PPV per patient was 86.5%, which was 75.8% for stage I disease compared with 89.7%, 100%, and 90.6%, respectively, for disease stages II to IV (p = .037). The PPV per biopsy specimen of stages I to IV endometriosis was 66.1%, 78.0%, 92.0%, and 81.1%, respectively (.049). When endometriomas and peritoneal biopsy specimens were analyzed separately, no difference in PPV existed (79% vs 77%; p = .67). Conclusion High overall PPV existed in our study, especially in patients with advanced disease. The PPV per patient was higher than the PPV per biopsy specimen indicating that ability to diagnose endometriosis may be improved by performing multiple biopsies. This is particularly true in stage I where failure to confirm may be greatest.

Hepatic Hereditary Hemorrhagic Telangiectasia

A 31-year-old woman underwent an exploratory laparoscopy for evaluation of chronic pelvic pain. She was found to have mild endometriosis; however, an incidental finding was that intraoperatively the liver was noted to be abnormal, with nodularity and discrete telangiectasias noted throughout the entire surface (Figure A). A triphasic computed tomography scan of the abdomen showed heterogeneous enhancement of hepatic parenchyma, premature opacification of hepatic veins (striped arrows), and dilated tortuous arterial branches (solid arrow) in the arterial phase (Figure B).

1130: Diagnosis of pelvic congestion syndrome with transabdominal and transvaginal ultrasound

1130: Diagnosis of pelvic congestion syndrome with transabdominal and transvaginal ultrasound

Role of laparoscopy in evaluation of chronic pelvic pain

Introduction:Chronic pelvic pain (CPP) is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination.Settings and Design:A retrospective study of patients who underwent diagnostic laparoscopy for CPP.Materials and Methods:The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available.Statistical analysis used:McNemar Chi-square test for frequencies in a 2 × 2 table.Results:The most common presentation was acyclic lower abdominal pain (79.1%), followed by congestive dysmenorrhoea (26.7%). 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%), followed by pelvic congestion (18.6%). Laparoscopic adhesiolyis achieved pain relief only in one-third of the women.Conclusion:The study revealed very low incidence of endometriosis (4.7%). Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001). Adhesiolysis helps only small proportion of women in achieving pain control.

The role of laparoscopic surgery in the evaluation of chronic pelvic pain of unknown origin: pitfalls with a negative laparoscopic findings

The role of laparoscopic surgery in the evaluation of chronic pelvic pain of unknown origin: pitfalls with a negative laparoscopic findings

Garnerella vaginalis bacteremia after vaginal myomectomy

A 49-year-old woman was referred for evaluation of chronic pelvic pain and genital bleeding. Past medical history was otherwise unremarkable and she had one previous vaginal delivery. Pelvic examination revealed a posterior fibroma. Pelvic sonography confirmed a single interstitial posterior fibroma (65 mm 56 mm 45 mm) and a left anechogenous collection (91 mm 74 mm). At diagnostic laparoscopy adhesiolysis between left tubal and sigmoid was performed and a liquid collection evacuated. The ovaries were normal, but access to the posterior fibroma was limited by synechia between fibroma and rectum. At the end of laparoscopy, vaginal myomectomy was performed. No complication occurred during intervention. Prophylactic antibiotics were given during intervention (cefoxitrin 1 g IV). On postoperative day 3, patient had hyperthermia with pelvic pain. Two blood cultures were positives with Garnerella sp. and one blood culture was positive with Peptostreptococcus sp. Antibiotics including metronidazole were administered. On postoperative day 6, vaginal examination revealed an abscess of the vaginal cuff confirmed by pelvic sonography. Vaginal surgical evaluation was performed. Postoperative evolution as normal and patient discharged on postoperative day 11. 2. Discussion

Endometriosis: Correlation between histologic and visual findings at laparoscopy

Objective: The purpose of this study was to correlate the diagnosis of endometriosis on the basis of visualization at laparoscopy with the pathologic diagnosis. Study Design: A prospective study of 44 patients undergoing laparoscopy for the evaluation of chronic pelvic pain was carried out. All areas suggestive of endometriosis were excised and examined pathologically. Peritoneal biopsy specimens were obtained from areas of normal-appearing peritoneum to rule out microscopic endometriosis. All lesions were identified by anatomic site. Visual and histologic American Fertility Society scores were compared. The positive predictive value, sensitivity, negative predictive value, and specificity were determined for visually identified endometriosis versus the histologic correlate. Results: The mean prevalence of abnormalities visually consistent with endometriosis was 36%, with 18% confirmed histologically. The positive predictive value was 45%; sensitivity, 97%; negative predictive value, 99%; and specificity, 77%; for visual versus histologic diagnosis of endometriosis. Thirty-six percent of the diagnoses were downstaged on the basis of histologic findings. Conclusion: A diagnosis of endometriosis should be established only after histologic confirmation. (Am J Obstet Gynecol 2001;184:1407-13.)

Prevalence of Endometriosis in Adolescent Girls With Chronic Pelvic Pain Not Responding to Conventional Therapy

Study ObjectiveTo evaluate adolescent girls with chronic pelvic pain not responding to conventional medical therapy, using advances in operative laparoscopy to determine endometriosis prevalence, clinical stage, and type of lesion. DesignA descriptive retrospective study of subjects who (1) were referred for the evaluation of chronic pelvic pain, (2) did not respond to a nonsteroidal anti-inflammatory drug and an oral contraceptive pill, and (3) underwent a laparoscopy to determine the etiology of the pelvic pain. SettingPatients referred to a surgical gynecologist in a pediatric/adolescent gynecology and reproductive endocrine academic practice. ParticipantsAll patients younger than 22 years of age with chronic pelvic pain. InterventionOperative laparoscopy to determine the etiology of the chronic pelvic pain. Main Outcome MeasuresOperative laparoscopy results including stage and description of endometriosis. ResultsMore than two thirds of the study population (69.6%) was found to have endometriosis. All subjects had either stage I or II as determined by the American Fertility Society's classification system. The nature of the pain in the 32 subjects with endometriosis was both acyclic and cyclic in 20 (62.5%), acyclic only in 9 (28.1%), and cyclic only in 3 (9.4%). Other presenting symptoms included gastrointestinal in 11 (34.3%), urinary in 4 (12.5%), and irregular menses in 3 (9.4%). ConclusionsAdolescents with chronic pelvic pain not responding to medical therapy have a high rate of endometriosis and should be referred to a gynecologist who is experienced with the subtle laparoscopic findings of atypical endometriosis to diagnose the etiology of the pelvic pain and initiate appropriate therapy.

The role of laparoscopy in the evaluation of chronic pelvic pain: Pitfalls with a negative laparoscopy

Laparoscopic findings are negative in anywhere from 10% to 90% of women with chronic pelvic pain. When this occurs a woman is often told one or more of the following: (1) nothing is wrong; (2) the pain is in her head and she should see a psychiatrist; (3) she should have a neurolytic procedure, such as uterine nerve transection or presacral neurectomy; (4) the only thing that is left to do is a hysterectomy; or (5) nothing can be done and she must learn to live with the pain. Usually these statements are inappropriate, often stemming from the mistaken belief that laparoscopy represents the definitive diagnostic end point in the evaluation of a woman with chronic pelvic pain. It is important that gynecologists appreciate that laparoscopy is only one of many possible methods of evaluation and recognize its diagnostic limitations and pitfalls.

Urethral syndrome presenting as chronic pelvic pain

AbstractWe present and characterize eight patients who were referred for gynaecologic evaluation of chronic pelvic pain but were found to have their symptoms resulting from urethral syndrome secondary to chronic urethritis. All patients complained of chronic lower abdominal pain, dyspareunia and in some instances vulvar burning. Length of symptoms ranged from 7 months to 6 years. All patients had been treated in the past for vaginitis, pelvic inflammatory disease, endometriosis and/or urinary tract infections with no resolution of symptoms. When questioned specifically, all patients related a history of postcoital voiding dysfunction. Initial pelvic examination revealed urethral and subtrigonal tenderness. All patients then underwent a standard detailed urogynaecologic evaluation. The history, voiding diary and pelvic examination confirmed the initial findings. Urine cultures were all negative. Cystourethroscopy revealed findings of urethral erythema, exudate and cystic inclusions in the urethral wall. Al...

Pelvic Pain and Infections

Infectious etiologies of both acute and chronic pelvic pain are common and may involve multiple organ systems. In the evaluation of the acute pain, it is important to remember that rapidity of diagnosis is important because of the possibility of significant morbidity and even death if a condition is not attended to rapidly. In recent years, laparoscopic evaluation of the pelvis has provided a better understanding of the pathophysiology of some of these infections, as well as possible therapeutic maneuvers. The evaluation of chronic pelvic pain requires a thorough attempt at careful diagnosis with minds open to the possibility that other organ systems besides the genital tract may be involved. Laparoscopy also may be an important diagnostic and therapeutic tool in the evaluation of the sequelae of pelvic inflammation leading to chronic pelvic pain. All therapeutic modalities that are instituted on the basis of the diagnostic evaluation must take into consideration that a strong emotional component is generally associated with chronic pelvic pain. Such components must be addressed in order to achieve the best possible results for the patient.