Challenges in chronic pelvic pain: Diffuse uterine capillary haemangioma simulating a clinical picture of adenomyosis

Introduction: Adenomyosis is a heterogeneous condition of difficult diagnosis that stands out in our patients for causing abundant menstrual bleeding, dyspareunia and dysmenorrhoea. However, in chronic pelvic pain units it is important to consider other conditions of similar symptomatologies, such as vascular malformations. These include capillary haemangiomas which, although rare in the reproductive tract, can produce serious symptoms. Case description: We present the case of a 31-year-old woman under observation by the chronic pelvic pain unit for dysmenorrhoea and dyspareunia since menarche. Ultrasound and magnetic resonance findings were compatible with adenomyosis. The patient showed no improvement with hormonal treatment. Upon failure of the medical treatment and taking into account the patient’s lack of gestational desire, a laparoscopic hysterectomy was performed. The pathological report revealed a diffuse capillary haemangioma as the cause of the symptoms. Given the completely curative nature of surgery for this type of condition, the patient was discharged from our unit. Conclusion: The preoperative diagnosis of adenomyosis is still a challenge and units specializing in chronic pelvic pain must consider all possible diagnostic options so as not to overlook rarer conditions such as vascular malformations.

Download Full-text

Patient with Chronic Pelvic Pain from Endometriosis

10.2310/pm.15021 ◽

2016 ◽

Author(s):

Jianguo Cheng ◽

Yoon-Jeong Cho

Keyword(s):

Pelvic Pain ◽

Hormonal Therapy ◽

Chronic Pelvic Pain ◽

Reproductive Tract ◽

Visceral Pain ◽

Surgical Removal ◽

Antiinflammatory Drugs ◽

Persistent Symptoms ◽

Incomplete Removal ◽

Management Procedures

Endometriosis, a chronic and progressive condition characterized by the presence of endometrial tissue outside the uterus, accounts for about one third of the cases of chronic pelvic pain in women. Pain in endometriosis may be due to nociceptive, inflammatory, and/or neuropathic mechanisms. The clinical presentation is often variable between patients, and diagnostic laparoscopy for visualization and biopsy of lesions is the gold standard for diagnosis. The treatment may consist of two elements: chronic pelvic pain itself as a diagnosis and endometriosis as a disease. Hormonal therapy is used to reduce the amount of estrogen and hence reduce symptoms such as pelvic pain and dysmenorrhea. In patients with severe endometriosis, surgical removal of lesions, adhesions, and cysts and restoration of pelvic anatomy may be preferred. Both hormonal and surgical treatments have been shown to be effective in decreasing pain symptoms associated with endometriosis. A variety of analgesics, including nonsteroidal antiinflammatory drugs, opioids, tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, and antiepileptic drugs, have been used to ameliorate pain in endometriosis, with varying degrees of success. In patients with persistent symptoms, interventional pain management procedures may be performed to target the visceral and somatic organs and their innervations. Infertility is the most common complication of endometriosis. Between 10 and 20% of women with endometriosis have recurrence of the disease regardless of the treatment they receive. The recurrence of pain may be due to remodeling of the central nervous system, the role of the reproductive tract in reactivating pain, and incomplete removal or recurrence of lesions. This review contains 2 tables and 52 references Key words: chronic abdominal pain, chronic pelvic pain, dyschezia, dysmenorrhea, dyspareunia, endometrioma, endometriosis, hormonal therapy, infertility, retrograde menstruation, visceral pain

Download Full-text

Total laparoscopic hysterectomy: overtreatment for misdiagnosed organic cause or undertreatment for idiopathic chronic pelvic pain?

Journal of Endometriosis ◽

10.5301/je.5000183 ◽

2014 ◽

Vol 6 (4) ◽

pp. 190-195

Author(s):

Salvatore Gizzo ◽

Concetta Leggieri ◽

Lorena Conte ◽

Stefano Luisi ◽

Errico Zupi ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy

Download Full-text

Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain

Obstetrics and Gynecology ◽

10.1097/aog.0000000000001604 ◽

2016 ◽

Vol 128 (3) ◽

pp. 658 ◽

Cited By ~ 1

Author(s):

Wei Ting Xia ◽

Yao Yao Cai ◽

Si Meng Yang ◽

Xue Qing Wu ◽

Martin J. Quinn

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Laparoscopic Hysterectomy

Download Full-text

Endometriosis

Pediatrics in Review ◽

10.1542/pir.4.7.212 ◽

1983 ◽

Vol 4 (7) ◽

pp. 212-230

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Reproductive Tract ◽

Medical Center ◽

Uterine Cavity ◽

Female Reproductive Tract ◽

Female Adolescents ◽

Physical Finding ◽

Irregular Menses ◽

Bladder Symptoms

Laparoscopy was performed on 140 female adolescents (aged 10 to 19 years) for chronic pelvic pain at Boston Children's Hospital Medical Center. Endometriosis (without other pelvic pathology) was encountered in 47% of these patients. Pelvic pain was both cyclic and acyclic and typically began 2.9 years after menarche. Other symptoms included irregular menses, gastrointestinal and bladder symptoms, and increased vaginal discharge. The diagnosis of endometriosis had not been made preoperatively in the majority of patients despite repeated pelvic examinations and thorough evaluation of gastrointestinal and genitourinary tracts. The most constant physical finding preoperatively was tenderness with or without cul-de-sac nodularity. Comment: Endometriosis is a disorder of the female reproductive tract characterized by the finding of endometrial tissue in locations outside the uterine cavity.

Download Full-text

Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain

Obstetrical & Gynecological Survey ◽

10.1097/01.ogx.0000499755.80840.50 ◽

2016 ◽

Vol 71 (10) ◽

pp. 589-591

Author(s):

Erika L. Mowers ◽

Courtney S. Lim ◽

Bethany Skinner ◽

Nichole Mahnert ◽

Neil Kamdar ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Laparoscopic Hysterectomy

Download Full-text

Pelvic Pain in Adolescents

Seminars in Reproductive Medicine ◽

10.1055/s-0038-1676088 ◽

2018 ◽

Vol 36 (02) ◽

pp. 116-122 ◽

Cited By ~ 4

Author(s):

Sawsan As-Sanie ◽

Noam Smorgick

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Systematic Approach ◽

Reproductive Tract ◽

Myofascial Pain ◽

Adult Women ◽

Depression And Anxiety ◽

Psychosocial Counseling ◽

Irritable Bowel

AbstractDysmenorrhea and noncyclic pelvic pain (chronic pelvic pain) are common in adolescents. The evaluation of teens with dysmenorrhea or chronic pelvic pain is aimed to diagnose possible gynecologic conditions (endometriosis, pelvic inflammatory disease, ovarian cysts, and obstruction of the reproductive tract) and nongynecologic conditions (irritable bowel syndrome, interstitial cystitis, and myofascial pain). The management of chronic pelvic pain in adolescents is often more complex than in adult women because both the adolescent and her parents are counseled and addressed, and her long-term emotional and physical health, fertility, and sexuality are considered. Dysmenorrhea and chronic pelvic pain are often associated with depression and anxiety in adolescents. Thus, psychosocial counseling plays an important role in the management of these patients. This review will present a systematic approach to the evaluation and treatment of dysmenorrhea and chronic pelvic pain in adolescents.

Download Full-text

Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain

Obstetrics and Gynecology ◽

10.1097/aog.0000000000001422 ◽

2016 ◽

Vol 127 (6) ◽

pp. 1045-1053 ◽

Cited By ~ 34

Author(s):

Erika L. Mowers ◽

Courtney S. Lim ◽

Bethany Skinner ◽

Nichole Mahnert ◽

Neil Kamdar ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Laparoscopic Hysterectomy

Download Full-text

Sacral Neuromodulation: Foray into Chronic Pelvic Pain in End Stage Endometriosis

Case Reports in Neurological Medicine ◽

10.1155/2017/2197831 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Maija Lavonius ◽

Pia Suvitie ◽

Pirita Varpe ◽

Heikki Huhtinen

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Sacral Neuromodulation ◽

Pulse Generator ◽

Hormonal Treatment ◽

Pelvic Organ ◽

Testing Period ◽

End Stage ◽

Extensive Surgery

Excision of all endometriotic lesions is the method of choice in the treatment of severe endometriosis resistant to medical therapy. The infiltrating nature of the disease as well as extensive surgery may, however, cause chronic pain that cannot be relieved by either surgery or hormonal treatment. As a pilot treatment, we tested the effect of sacral neuromodulation (SNM) for four endometriosis patients suffering chronic pelvic pain and pelvic organ dysfunction after radical surgical treatment. Three out of four patients reported improvement in their symptoms during the neuromodulation testing period and a permanent pulse generator was installed. After 2.5 years, all three patients report better quality of life and want to continue with SNM.

Download Full-text