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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We evaluated the effects of low-dose oral contraceptive (Desolett) in the management of pelvic pain, and its sensitivity in differentiating organic disorders such as endometriosis, in 96 women who were followed for at least 4 to 6 months. The 67 who still complained of pelvic pain with no improvement in severity, or who reported increase in symptoms after 4 to 6 months were examined by laparoscopy. All patients underwent laparoscopy in the follicular phase, under general anesthesia with the three-puncture technique. Fifty-six women (83.6%) were diagnosed as having endometriosis, 19 stage 1, 31 stage 2, and 6 stage 3 disease (American Fertility Society classification). Six (9%) had moderate to severe pelvic adhesions (2 Fitz-Hugh-Curtis syndrome) with no endometriotic implants. One (1.5%) had Taylor syndrome, and the others (6%) were free of disease. Unresponsiveness to low-dose oral contraceptives at the end of 4 to 6 months was highly sensitive and predictive of organic pelvic disorders such as endometriosis as the cause of pelvic pain. Therefore, we conclude that this therapy is effective in evaluating and treating women with obscure findings for particular disorders. In addition to managing mild to moderate endometriosis, it is effective in reducing the severity of midline pelvic pain of uterine origin, which may be of further benefit in pelvic pain of obscure etiology. Finally, a trial of oral contraceptives may be used as initial screening in women with chronic pelvic pain to reduce the number of unnecessary diagnostic and surgical interventions.
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PMID:The Sensitivity of Low-Dose Oral Contraceptives in Differentiating Endometriosis in Patients with Pelvic Pain 907 47

Seventy-five women underwent diagnostic office laparoscopy under local anesthesia using a 1.9-mm microlaparoscope. Indications were infertility (40), pelvic pain (25), and uterine malformation (septate or bicornuate uterus) (10). All women tolerated the procedure well. In only two we could not evaluate the pelvic organs because of severe adhesions. Visualization of the pelvic organs was reasonable, although the size of the video image was smaller than the one obtained by laparoscopy. Operating time was 10 to 20 minutes. We believe that this is a safe, simple, effective, fast, and inexpensive way to evaluate pelvic disease and to obtain histologic samples.
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PMID:Microlaparoscopy 907 69

The Le Fort colpocleisis is an obliterative procedure used in the treatment of pelvic prolapse in elderly women where prolonged reconstructive surgery or general anesthesia may be medically contraindicated. Advantages include the ability to perform this procedure quickly under regional anesthesia with a low postoperative complication rate. The authors describe a previously unreported complication of partial colpocleisis requiring subsequent hysterectomy. A 92-year-old woman presented with a 10-day history of lower extremity edema and pelvic pain. She had recently undergone a second partial colpocleisis for recurrent pelvic prolapse in which the drainage channels were partially obliterated. Radiologic evaluation revealed an enlarged complex pelvic mass. At the time of laparotomy, an enlarged uterus filled with purulent material was noted which necessitated subsequent hysterectomy. It was concluded that, although uncommon, postoperative infection is a recognized complication of Le Fort colpocleisis. To minimize the chance of abscess, adequate lateral channels should be created and maintained during colpocleisis to allow drainage of postoperative secretions, bleeding and inflammatory exudate.
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PMID:Pyometra following Le Fort colpocleisis. 912 84

Presented is the case of a 37-year-old South Australian woman who experienced intractable pelvic pain following laparoscopic sterilization with Filshie clips. The pelvic anatomy was normal and one Filshie clip was applied to each Fallopian tube. The patient stated she had experienced right-sided lower abdominal pain that radiated down the anterior part of her right thigh since regaining consciousness after general anesthesia. The pain had failed to resolve seven days after the procedure and the patient was unable to perform even simple tasks. Analgesics provided only temporary, partial relief. There were no signs of infection or any other exacerbating condition. At diagnostic laparoscopy, instillation of bupivacaine around the clip provided transient relief, but the pain returned the next day at the same level of severity. After one month of intractable pain, laparoscopic bilateral salpingectomy was performed to remove the clips and the pain disappeared. Although back pain has been reported in up to 14% of women undergoing laparoscopic sterilization, this is the first published case of long-term abdominal pain associated with the Filshie clip.
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PMID:Intractable pelvic pain following Filshie clip application. 922 79

To establish a protocol for conscious sedation in microlaparoscopy, we conducted a prospective, observational study of 74 women undergoing the procedure under local anesthesia with conscious sedation for the evaluation and treatment of chronic pelvic pain. Our protocol for conscious sedation allowed us to perform diagnostic microlaparoscopy under local anesthesia in all 74 women and operative microlaparoscopy in 52 (70.2%). This procedure is a safe and effective alternative to general anesthesia during microlaparoscopy in selected patients.
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PMID:A protocol for conscious sedation in microlaparoscopy. 934 67

The objective of this study was to determine visual quality, diagnostic accuracy, and surgical merits of small diameter laparoscopy (SDL). Thirty-seven patients were randomly selected. The indications for laparoscopy were infertility, desire for tubal sterilization or chronic pelvic pain. Patients underwent SDL, followed by conventional laparoscopy (CL) as a control under general anaesthesia. Findings at operation were compared. The mean time for diagnostic work-up was longer with SDL than CL, 11.7 +/- 5.6 versus 7.6 +/- 3.2 min respectively (P < 0.04). Visual quality was scored from 4 to 1 by the operator; mean visual quality, mean endometriosis score and mean adnexal adhesions score were slightly lower with SDL than CL. Sensitivity of SDL in diagnosing endometriosis, adhesions, ovarian, uterine and pouch of Douglas lesions were 71, 58, 81, 89 and 73% respectively; specificity was 100, 96, 100, 100, 100% in the same order. Suction irrigation, cyst aspiration, tissue biopsies, simple adhesiolysis, tubal ligation and cauterization were easily performed with SDL. We conclude that SDL seems a good alternative to CL in diagnosing macro-pelvic anatomy and coarse pelvic pathologies and may also be good in performing surgical procedures such as: tubal ligation, biopsies and differential diagnosis of pelvic fluids. But SDL must be used cautiously in micro-oriented, functional conditions such as infertility, pelvic pain, endometriosis and adhesion scoring or treatment. SDL may be regarded as a less invasive but less sensitive tool with limited surgical merits.
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PMID:Small diameter versus conventional laparoscopy: a prospective, self-controlled study. 943 72

The appendix is an under-appreciated source of chronic pelvic pain. Laparoscopic evaluation of the appendix is limited without intra-operative patient feedback on the presence and absence of pain. New techniques using local anaesthesia with conscious sedation have enabled us to perform operative laparoscopic surgery while the patient is awake. We report the first two cases of microlaparoscopic appendectomies performed under local anaesthesia with conscious sedation following diagnosis obtained during conscious pain mapping.
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PMID:Appendectomy under local anaesthesia following conscious pain mapping with microlaparoscopy. 957 17

A case of spontaneous heterotopic pregnancy (simultaneous intra- and extrauterine) with living embryos is described. A 26 year old primigravida, affected by threatened abortion at 7 weeks gestation with right pelvic pain underwent a transvaginal sonography which allowed a certain diagnosis. A minilaparotomy with right salpingectomy was performed at the 8th week of gestation. Intrauterine pregnancy was uneventful and a healthy female infant was delivered at term weighting 3200 g. The international literature concerning heterotopic pregnancy is reviewed. Diagnostic and therapeutic aspects are discussed in the light of this case. Heterotopic pregnancy is an insidious pathology with a constant increase of incidence that should be considered as a diagnostic possibility in all cases at risk. Minilaparotomic salpingectomy in general anesthesia is probably the safest treatment for the patient and the least traumatic for a good outcome of her intrauterine pregnancy.
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PMID:[Spontaneous heterotopic pregnancy with live embryos: an insidious echographic problem in the first trimester. Therapeutic problems. A clinical case and review of the literature]. 969 40

The timely diagnosis of intra-abdominal pathology continues to be an elusive problem. Delays in diagnosis and therapeutic decision making are continuing dilemmas in patients who are females of childbearing age, elderly, obese or immunosuppressed. Minilaparoscopy without general anesthesia potentially can provide an accurate, cost-effective method to assist in the evaluation of patients with acute abdominal pain. Laparoscopy without general anesthesia is not a new technique, but with the combination of two emerging factors--1) the introduction of new technology with the development of improved, smaller laparoscopes and instruments, and 2) the shifting of emphasis on healthcare to a more cost-effective managed care environment--its value and widespread utilization is being reconsidered. We report the case of a 22 year old female with an acute onset of increasing abdominal and pelvic pain. Despite evaluation by general surgery, gynecology, emergency room staff, as well as, non-invasive testing, a clear diagnosis could not be made. In view of this, minilaparoscopy without general anesthesia was performed and revealed an acute, retrocecal appendicitis. The diagnosis was made with the assistance from the conscious patient. The utilization of this technique greatly expedited the treatment of this patient. Full-sized laparoscopic equipment was then used to minimally invasively remove the diseased appendix under general anesthesia. Both procedures were well tolerated by the patient.
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PMID:Minilaparoscopy without general anesthesia for the diagnosis of acute appendicitis. 987 17

Office laparoscopy under local anesthesia is especially suited to meet the current pressures of quality versus cost in an era of managed care. It is likely that this technique will soon become a major part of the practicing gynecologist's diagnostic operative armamentarium. Advantages of office microlaparoscopy under local anesthesia are realized by the practitioner, the patient, and the managed care provider. Office microlaparoscopy under local anesthesia is a safe, effective, and less costly tool for the evaluation of patients with many different indications. To date, the procedure has been primarily used for patients with infertility, chronic pelvic pain, and tubal ligation. The ease of scheduling, reduced costs, and rapid recovery suggest that it may be the preferred initial procedure for these patients.
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PMID:Office microlaparoscopy under local anesthesia. 1008 33


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