Retained intrauterine device, Lippes loop intrauterine device, for 40 years as unusual cause of chronic pelvic pain in 70 years old woman in Western Ethiopia

Chronic Pelvic Pain (CPP) is defined as chronic or persistent pain perceived in structures related to the pelvis for at least 6 months. This condition accounts for 10% of all outpatient gynecology visits and it significantly affects patients’ health. Etiologies of chronic pelvic pain are multifactorial in nature and vary with patients’ age. But retained intrauterine device in the uterus beyond its expiry date was not reported as the cause of chronic pelvic pain in postmenopausal age group. This case is presented to show that retained (expired) intrauterine device left in situ in postmenopausal woman could cause chronic pelvic pain. In conclusion, intrauterine devices in situ should be remembered at menopause and removed per the guideline before it causes problems and unnecessary interventions

Role of diagnostic laparoscopy in chronic pelvic pain

Background: Laparoscopy in chronic pelvic pain can reveal findings that cannot be detected clinically, so it can be treated and diagnosed at same sitting. This study was undertaken to evaluate role of diagnostic laparoscopy in chronic pelvic pain.Methods: It was a prospective study conducted at department of Obstetrics and Gynecology, ESI PGIMSR, Basaidarapur, New Delhi. The study was carried out from 2012- 2014. Total 110 cases were enrolled. 55 cases who had been suffering from chronic pelvic pain for ≥6 months were taken as study group (A). 55 cases without any symptoms that underwent laparoscopic sterilization were taken as control group (B). Results were statistically analyzed using Karl Pearson's correlation coefficient.Results: Chronic pelvic pain whereas on laparoscopy normal finding were seen only in 25.45% cases. This difference was found to be statistically significance (P value 0.04). Normal findings were seen in 60% cases of chronic pelvic pain on USG as compared to 25.14% cases on laparoscopy was statistically significant .( p value <0.05.)Conclusions: Laparoscopy is a gold standard tool in evaluation of women with chronic pelvic pain, because diagnosis and often treatment can be accomplished in one sitting, without subjecting them to exploratory laparotomy

Chronic pelvic pain in women: comparative study between ultrasonography and laparoscopy as diagnostic tool

Background: Chronic pelvic pain is a major cause of morbidity among the reproductive age group women. The study on patients of chronic pelvic pain aimed to compare the diagnostic accuracy of ultrasonography and laparoscopy in these patientsMethods: The study was conducted on 100 patients of chronic pelvic pain attending the gynaecology outdoor and were subjected to thorough clinical examination followed by ultrasonography and laparoscopic examination.Results: Maximum number of cases of chronic pelvic pain belonged to 25-30 years, were parous with mean duration of pain of 15.2 months. The most common complaint was vaginal discharge (70%) followed by menstrual irregularity. On clinical examination, pelvic tenderness was observed in majority (60%) of cases. USG examination showed chronic pelvic inflammatory disease in 43% cases followed by myoma (8%), ovarian cyst (5%), endometriosis (6%), pelvic congestion (5%) and no abnormal pathology in 25% cases. On laparoscopic examination, chronic pelvic inflammatory disease was present in 47% cases followed by endometriosis (11%), pelvic congestion (8%), myoma (8%), adhesions (7%) while 13% cases showed normal findings.Conclusions: Laparoscopy is more effective than ultrasonography as a diagnostic tool in patients of chronic pelvic pain.

Chronic pelvic pain

Chronic pelvic pain is defined as pain in the pelvis lasting for more than six months (some say three). The pain may be experienced in any of the structures of the pelvis, including the gynaecological organs; the lower urinary and gastrointestinal tract; and the vascular, neural and musculoskeletal systems. The pain can be continual, cyclical, provoked or unprovoked, and is frequently multifocal. A woman who complains of painful sex, for example, may also report vulvovaginal pain and dyspareunia; bladder frequency, urgency and  suprapubic pain, as well as irritable bowel symptoms. Although an initiating event is sometimes described, such as an episode of severe “thrush” or cystitis, or following pelvic surgery or childbirth, this initial insult may be long forgotten and no longer relevant. Vulvodynia, endometriosis, bladder pain syndrome and irritable bowel syndrome are common causes of chronic pelvic pain in women but are often misdiagnosed and poorly  managed.Keywords: chronic pelvic pain, vulvodynia, vulvar vestibulitis, dyspareunia, painful sex, endometriosi

Синдром хронической тазовой боли в практике гинеколога

В роботі розкрито механізми виникнення хронічного тазового болю, його патогенетичні засади. Підкреслено тісний зв’язок між синдромом хронічного тазового болю та розвитком ендометріоїдної хвороби, наведено шляхи полегшення тазового болю при вказаній патології. В результаті проведених досліджень доведено високу ефективність дієногесту у подоланні хронічного тазового болю при ендометріозі.In the study the mechanisms of chronic pelvic pain origin and its pathogenetic bases are discussed. Underlined the close connection between chronic pelvic pain syndrome and endometrioid disease development, the ways of pelvic pain relief in this pathology are given. In the results of conducted investigations the high effectiveness of dienogest in chronic pelvic pain syndrome connected with endometriosis is proven

Оцінка стану внутрішніх статевих органів у жінок з безплідністю на фоні хронічного тазового болю

Проведено обследование женщин с бесплодием на фоне хронической тазовой боли. показано, что лапароскопия является высокоинформативным методом диагностики хронической тазовой боли у женщин с бесплодием.A survey of infertile women with chronic pelvic pain. It is shown that laparoscopy is a highly informative method of diagnosis of chronic pelvic pain in women with infertility

Diagnosis of caesarean section scar niche causing chronic pelvic pain

The common causes of chronic pelvic pain include chronic pelvic inflammatory disease, endometriosis, inflammatory bowel disease etc. Caesarean scar defect is recently recognized as a cause for chronic pelvic pain. A 33 years old para 2 with previous 2 caesarean sections, whose last child birth was 18 months back consulted for rectal pain of 4 months duration. She was treated with progesterones with a provisional diagnosis of endometriosis without much relief. She developed congestive dysmenorrhea and dyspareunia after last child birth. Her clinical examination revealed retroverted uterus with left forniceal tenderness. USG evaluation confirmed the clinical findings and evaluation of uterine scar was not undertaken as the possibility of caesarean scar defect (CSD) was not thought of as a cause for chronic pelvic pain. MRI pelvis reported semicircular myometrial defect at LSCS scar site and this was confirmed by hystero-laparoscopy and she was counselled to undergo repair of CSD. The case illustrated the clinical picture and diagnosis of CSD as a cause for chronic pelvic pain

A rare case of chronic endometritis treated with hysteroscopy

We present a case of 32 year old woman complaining of menometrorrhagia with chronic pelvic pain of following second trimester abortion. Her transabdominal ultrasound revealed chronic endometritis. She was treated with dilatation and curettage, on histopathological examination diagnosis of chronic endometritis was confirmed. Her menorrhagia was revealed but chronic pelvic pain persisted for which diagnostic hysteroscopy was planned. It revealed presence of tiny bony chips which were removed in the same setting. Intrauterine retained foetal bony chips due to previous medical termination of pregnancy were identified to be the cause of menometrorrhagia with chronic pelvic pain in the present case. Our case reiterates the importance of hysteroscopy in evaluation of such patients who are not responding to conventional medical management of abnormal uterine bleeding

Baropodometry on women suffering from chronic pelvic pain - a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Previous studies have associated chronic pelvic pain with a stereotyped pattern of movement and posture, lack of normal body sensations, a characteristic pain distribution. We aimed at evaluating if these postural changes are detectable in baropodometry results in patients with chronic pelvic pain.</p> <p>Methods</p> <p>We performed a prospective study in a university hospital. We selected 32 patients suffering from chronic pelvic pain (study group) and 30 women without this pathology (regular gynecological work out - control group). Pain scores and baropodometric analysis were performed.</p> <p>Results</p> <p>As expected, study group presented higher pain scores than control group. Study and control groups presented similar averages for the maximum pressures to the left and right soles as well as soles supports in the forefeet and hind feet. Women suffering from chronic pelvic pain did not present differences in baropodometric analysis when compared to healthy controls.</p> <p>Conclusions</p> <p>This data demonstrates that postural abnormalities resulting from CPP could not be demonstrated by baropodometric evaluation. Other postural measures should be addressed to evaluate pelvic pain patients.</p

Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women

Chronic pelvic pain affects 2–24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea- and endometriosis-related pain. But recent randomized studies and meta-analysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter