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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic pelvic pain is a common and disabling condition affecting women of childbearing age. A specific diagnosis for the condition is often difficult, and referred pain from the abdominal viscera, neurogenic and psychogenic factors have all been implicated, as have pelvic conditions such as endometriosis, pelvic inflammatory disease and ovarian cysts; no diagnosis is made in 60% of patients. Pelvic congestion syndrome (PCS), the presence of varices of the pelvic veins, has been shown to be the underlying aetiology in a significant proportion of patients with chronic pelvic pain; the development of these varices is caused by a combination of endocrine and mechanical factors. Given the positional nature of these varices, they are rarely diagnosed with conventional methods such as B-mode ultrasound and diagnostic laparoscopy. Diagnosis is best made with selective ovarian venography, although newer, non-invasive methods such as magnetic resonance imaging and duplex ultrasound are increasingly gaining favour. Pelvic varices are eminently treatable, either using ovarian suppression or by the ligation or embolization of the pelvic veins.
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PMID:Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. 1826 60

The appendicitis is one of the most common entities that could be met at surgical department. Chronic pelvic pain of right iliac fossa is common and it causes disability and distress and results in significant costs to health services. Often, investigation by laparoscopy reveals no obvious cause for pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, the vascular hypothesis where pain is thought to arise from dilated pelvic veins in which blood flow is markedly reduced and altered spinal cord and brain processing of stimuli in women with chronic pelvic pain. As the pathophysiology of chronic pelvic pain is not well understood, its treatment is often unsatisfactory and limited to symptom relief. We aimed to identify and review treatments for chronic pelvic pain related to appendicitis. Frequently ultrasound and CT scan cannot confirm the diagnosis of chronic appendicitis due to non significant swelling of vermiform appendix. The study excludes patients with a diagnosis of pelvic congestion syndrome, those with pain known to be caused by gynecological disorders or irritable bowel syndrome. Detailed history, clinical examination, and serological and radiological investigations failed to reveal the cause of the pain in all cases. We presumed that pain is caused by chronic appendicitis with appendicolithiasis and that removal of appendix will result in symptom relief. We performed study with 75 patients treated by laparoscopic appendectomy. Duration of symptoms ranged from 3 to 48 months, with a mean of 13.1 months. All patients included in this study had right iliac fossa pain lasting more than three months. We performed radiological contrast studies to verify appendicolithiasis of irregularity of appendicular wall. Patient with mild symptoms were excluded, only patients that have symptoms that cause disability were operated. We compared pain according to localization, duration and character. We evaluated the pain one month after operation and compared its characteristics with preoperative pain. There is strong evidence that postoperative pain is significantly lower in operated patients and most of them are without any symptoms after operation.
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PMID:Laparoscopic treatment of lower abdominal pain related to chronic appendicitis. 1946 67

Chronic pelvic pain (CPP) is a common gynecological complaint. CPP is nonmenstrual pain localized in the anatomic pelvis of at least 6 months' duration without any identifiable organic cause that is severe enough to cause functional disability and require treatment. Pelvic congestion syndrome (PCS) is a poorly understood disorder and often overlooked cause of pelvic pain. Ovarian vein reflux (OVR) and pelvic varicosities are a cause of PCS. On the other hand, OVR can be seen in asymptomatic women, typically parous. OVR has a characteristic appearance at enhanced computed tomography (CT). Contrast medium retrogradely fills the ovarian veins and parauterine veins during the arterial phase after intravenous contrast administration. CT is not the ideal modality to evaluate all the causes of pelvic pain, but CT is a commonly used diagnostic modality to screen patient who presents with abdominal and pelvic pain. CT can demonstrate abnormal ovarian venous flow as well as tortuous and dilated ovarian and pelvic veins. Ovarian vein reflux is important to recognize and when correlated with patient clinical presentation may help in the diagnosis of PCS.
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PMID:What is the significance of ovarian vein reflux detected by computed tomography in patients with pelvic pain? 1955 54

Chronic pelvic pain (CPP) is a common complaint of women presenting for gynecologic and primary care. Evaluation of CPP requires obtaining a careful history including not only obstetrical and gynecologic information but also screening for gastrointestinal, urologic, musculoskeletal, and neurological disorders. A detailed physical examination is also necessary. Management of CPP depends largely on the cause. Gynecologic causes include endometriosis, pelvic inflammatory disease, adhesive disease, pelvic congestion syndrome, ovarian retention syndrome, ovarian remnant syndrome, adenomyosis, and leiomyomas. Some non-gynecologic causes are interstitial cystitis/painful bladder syndrome, irritable bowel syndrome, pelvic floor tension myalgia, and abdominal myofascial pain syndrome. Treatments may be directed toward specific causes or may be targeted to general pain management. The most effective therapy may involve using both approaches. The diagnosis and treatment of each of the above disorders, and the management of CPP itself, is discussed.
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PMID:Management of chronic pelvic pain. 2093 29

Menstrual complaints are common and include pain, abnormal bleeding, and menstrual irregularity. The etiology is wide-ranging and includes endometriosis, fibroids, adenomyosis, pelvic congestion syndrome, pelvic inflammatory disease, endometrial hyperplasia, and polyps. Polycystic ovarian syndrome and some congenital uterine anomalies may present with menstrual disturbance and have been included in this review. Transvaginal ultrasound is widely used as first-line investigation. Magnetic resonance imaging is used increasingly with high diagnostic accuracy and confidence. Its multiplanar capacity and superior tissue contrast resolution enable accurate presurgical mapping of fibroids, deep pelvic endometriosis, and adenomyosis. Similarly, accurate differentiation of congenital uterine anomalies depends on multiplanar imaging with either 3-dimensional ultrasound or magnetic resonance imaging. Recent advances in imaging and radiological intervention, combined with an understanding of the underlying causes of menstrual dysfunction, therefore aid in accurate diagnosis and optimal treatment planning.
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PMID:Radiology of benign disorders of menstruation. 2097 60

Chronic pelvic pain is a common problem for female patients and is defined as pain that has been present for 6 months or more. Chronic pelvic pain with associated ovarian vein varicosities is termed pelvic congestion syndrome (PCS) and is an important but under-diagnosed condition. The aetiology of pelvic varicosities is reflux of blood in the ovarian veins due to the absence of functioning valves, resulting in retrograde blood flow and eventual venous dilatation. The cardinal presenting symptom of PCS is pelvic pain, usually described as a dull ache, without evidence of inflammatory disease. Clinical signs may include vulval varicosities extending on to the medial thigh and long saphenous territory as well as tenderness on deep palpation at the ovarian point; however, such signs are not always present. Non-invasive imaging (ultrasound, CT and magnetic resonance venography) plays a central role in establishing the diagnosis, excluding alternative causes of pelvic pain and providing a road map for novel minimally invasive treatment options that are now available. Day-case percutaneous-directed venous embolisation is now accepted as a valuable treatment option for PCS with promising results from early clinical trials and is fast becoming the first-line treatment option for this condition. This paper aims to raise awareness of PCS among clinicians and reviews the pathogenesis, imaging assessment and minimally invasive treatment options that are now available.
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PMID:Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. 2110 7

Therapeutic embolization of the gonadal veins is performed on male and female patients for different clinical situations using similar techniques. The testicular varicocele is a common clinical problem associated with pain and reduced fertility rates. In women, chronic pelvic pain can be attributed to pelvic congestion syndrome, which is said to result from retrograde flow in incompetent ovarian veins. Both of these clinical problems respond well to gonadal vein embolization. In this article, we review the clinical evaluation, diagnostic workup, and technical aspects of percutaneous intervention of gonadal vein embolization. The supporting literature is also reviewed.
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PMID:Gonadal vein embolization: treatment of varicocele and pelvic congestion syndrome. 2132 16

We present a case of pelvic venous congestion in a 13-year-old girl who complained of pelvic pain for 9 months. The diagnosis of pelvic congestion syndrome was suggested by imaging modalities, including sonography, CT and MRI, with classically described imaging findings. The girl underwent diagnostic laparoscopy, where visual inspection demonstrated congested pelvic veins and endometriosis. After removal of endometrial implants, the child's pain persisted and she subsequently underwent venography and embolization of the ovarian veins. We found no literature describing pelvic venous congestion (PVC) in children. Knowledge that PVC exists in children is important, particularly for pediatric radiologists who are imaging patients with complaints of pelvic pain.
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PMID:Radiologic findings of pelvic venous congestion in an adolescent girl with angiographic confirmation and interventional treatment. 2191 68

Chronic pelvic pain is a common condition. The sources of pelvic pain are multifactorial, and their causes are difficult to determine. Pelvic congestion syndrome (PCS) is associated with varicose ovarian veins and/or varicose veins in the pelvis. The syndrome is associated with constant dull pelvic pain, abnormal menstrual bleeding, tenderness to touch in lower abdomen, pain during intercourse, painful menstrual periods, vaginal discharge, PCOS. The specific diagnosis of Pelvic Congestion Syndrome is made using several tests which include ultrasound, CAT, MIR, MDCT (multidetector) and venogram. The ultrasound is the first test of choice. It can assess the uterus and other organs in the pelvis. Doppler ultrasound can also help visualize the blood flow and asses the presence of varicosities in the pelvis.
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PMID:[Current echography diagnosis of pelvic congestion syndrome]. 2323 72

Nutcracker syndrome is the term used to describe the patient with clinical symptoms of entrapment of the left renal vein between the aorta and the superior mesenteric artery. Pelvic congestion syndrome, which is a cause of chronic pelvic pain in women, may be due to Nutcracker syndrome. There are many modalities of treatment for Nutcracker syndrome. This is a case report of a 32-year old woman with pelvic congestion syndrome due to Nutcracker syndrome, who subsequently underwent laparoscopic transperitoneal left gonadal vein ligation. She has had complete remission of pain in 4 months after the operation and after 12 months of follow-up. Laparoscopic transperitoneal gonadal vein ligation is an approach that is safe, simple and provides good results for patient with pelvic congestion syndrome secondary to Nutcracker syndrome.
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PMID:Laparoscopic transperitoneal gonadal vein ligation for treatment of pelvic congestion secondary to Nutcracker syndrome: a case report. 2351 81


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