scholarly journals Chronic Pelvic Pain and Infertility Resulting from Unrecognized Retained Laminaria

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Wesley Nilsson ◽  
Sasha Mikhael ◽  
Jennifer Kaplan
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Transvaginal Ultrasound ◽  
Laminaria Japonica ◽  
The United States ◽  
Pathology Report ◽  
Operative Hysteroscopy ◽  
Menstrual Cycles ◽  
Patient Reported ◽  
Delayed Complications

Background. In 2013, the abortion rate in the United States was found to be 200 abortions per 1,000 live births. Of these, the CDC estimates that nearly 49% were performed using unsafe measures. Even when these procedures are safely performed, patients are at risk for immediate or delayed complications. In second-trimester terminations, mechanical dilation with an osmotic dilator is common to allow for delivery of the fetus. The Japanese seaweed Laminaria japonica is used to achieve this purpose. Case. A 28-year-old primigravida presented with chronic pelvic pain and infertility. She had irregular menstrual cycles and reported scant yellow discharge. A transvaginal ultrasound revealed an abnormally appearing endometrium with an elongated structure suspicious for a foreign body. The patient reported a voluntary termination of pregnancy twelve years earlier, for which laminaria were placed prior to the dilation and extraction. She underwent an operative hysteroscopy confirming our suspicion for retained laminaria. The pathology report demonstrated chronic severe endometritis and plant based material. Conclusion. Retained laminaria are associated with chronic pelvic pain and chronic infertility. Since they can be difficult to detect on conventional imaging, proper counting prior to insertion and after removal is an essential physician responsibility.

scholarly journals Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Isamarie Lora Alcantara ◽  
Shadi Rezai ◽  
Catherine Kirby ◽  
Annika Chadee ◽  
Cassandra E. Henderson ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Late Onset ◽  
Careful Examination ◽  
Surgical Removal ◽  
Tubal Occlusion ◽  
Patient Reported ◽  
Permanent Contraception ◽  
Laparoscopic Removal ◽  
Difficult Placement

Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device.Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device.Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.

scholarly journals Topical Amitriptyline-Ketamine for Treatment of Rectal, Genital, and Perineal Pain and Discomfort

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 485-488
Author(s):  
Mark D. P. Davis
Keyword(s):  
Adverse Effects ◽  
Pelvic Pain ◽  
Retrospective Review ◽  
Medical Records ◽  
Academic Medical Center ◽  
The United States ◽  
High Rate ◽  
Perineal Pain ◽  
Complete Relief ◽  
Patient Reported

Background: Pain in the rectal, genital, and perineal area is a common condition treated by pain physicians. These chronic pain syndromes are therapeutically challenging because both interventional and drug therapies often are ineffective. Objectives: To determine if pelvic pain can be treated effectively with compounded topical amitriptyline-ketamine. Study Design: A retrospective review of medical records. Setting: A single academic medical center in the United States. Methods: We identified all patients treated with topical amitriptyline-ketamine from January 1, 2004, through November 28, 2011. Medical records were evaluated to determine the diagnosis for which the medication was prescribed. Treatment efficacy and any adverse effects were recorded. Results: Of the 1,068 patients who received amitriptyline-ketamine, 13 had the medication prescribed for genital, rectal, or perineal pain and had medication efficacy recorded. These patients were treated with a topical combination of amitriptyline 1-2% and ketamine 0.5%. Of these 13 patients, one (8%) had complete relief, 6 (46%) had substantial relief, 4 (31%) had some relief, and 2 (15%) had no response. One patient reported occasional irritation while using topical amitriptyline-ketamine with lidocaine; no other patients reported local or systemic adverse effects. Limitations: Retrospective review; lack of uniform system for pain grading; concurrent use of other medications. Conclusions: Topical amitriptyline-ketamine provided a high rate of pain relief with a low adverse-effect burden in patients with pelvic pain. This topical medication could offer an effective, noninvasive, nonopioid therapy for pain in the rectum, perineum, and genitals. Key words: Amitriptyline, rectal, compounded medication, genital, ketamine, pain, pelvic, perineal.

scholarly journals A PROSPECTIVE CROSS SECTIONAL OBSERVATIONAL STUDY OF CHRONIC PELVIC PAIN IN ADOLESCENTS TRANSVAGINAL ULTRASOUND VERSUS LAPAROSCOPY

2021 ◽  
pp. 1-3
Author(s):  
Supriya Kumari ◽  
Surya Narayan ◽  
Kumudini Jha ◽  
Debarshi Jana
Keyword(s):  
Observational Study ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Transvaginal Ultrasound ◽  
Cross Sectional ◽  
Predictive Values ◽  
Medical College ◽  
Kappa Test ◽  
Laparoscopic Evaluation ◽  
Good Agreement

Background: Chronic pelvic pain (CPP)is cyclic or noncyclic, intermittent or constant discomfort in the pelvic region for at least 6 months. It is a common complaint in female adolescents that may be overlooked. Objective: To evaluate CPP in adolescents using transvaginal ultrasound (TVS) and laparoscopy. Study design: This is a prospective cross sectional observational study conducted at Obstetrics and Gynaecology Department of Darbhanga Medical College and Hospital, Laheriasarai, Bihar. A total of 100 adolescents with CPP were evaluated by TVS and laparoscopy and findings were analyzed. Results: The mean age of adolescents was 17 ± 3.5 the majority were parous (51%), rural (69%) and low social class (65 %). Diffuse pelvic pain was present in (62%), Dysmenorrheain (61%), deep abdominal and pelvic tenderness in (55% and 80% respectively). TVS was normal in (40%) andabnormalin (60%). Laparoscopic evaluation was normal in (29%)and abnormal in(71%) in the form of tubo- ovarian masses (19%),endometriosis (18%) ovarian cysts (9%), adenomyosis (8%), Adhesions (6%), PID and RVF uterus (4% for each), subserous fibroid and pelvic congestion (1% for each). sensitivity and specificity of TVS were (81.7% and 93.1% respectively). Positive and negative predictive values were 96.7% and 67.5% respectively. Kappa test between TVS and laparoscopy showed good agreement (kappa = 0.67). Conclusions: Good agreement was found between TVS and laparoscopy, however, laparoscopy is considered as a gold standard tool in evaluating adolescent CPP because of distinct advantages in terms of sensitivity and negative predictive value.

scholarly journals OC070: Can transvaginal ultrasound detect and localize endometriosis in women with chronic pelvic pain?

2003 ◽  
Vol 22 (S1) ◽  
pp. 19-19 ◽  
Author(s):  
E. Okaro ◽  
G. Condous ◽  
A. Khalid ◽  
M. Alkatib ◽  
D. Timmerman ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Transvaginal Ultrasound

scholarly journals Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Bradford W. Fenton ◽  
Scott F. Grey ◽  
Krystel Tossone ◽  
Michele McCarroll ◽  
Vivian E. Von Gruenigen
Keyword(s):  
Outcome Measures ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Latent Profile Analysis ◽  
Latent Class ◽  
Disease Process ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Essentially Normal ◽  
Patient Reported

Chronic pelvic pain affects multiple aspects of a patient’s physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients’ pain. Based on the 11 PROMIS domains applied to n=613 patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes.

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