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.

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Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

Journal of Personalized Medicine ◽

10.3390/jpm12010101 ◽

2022 ◽

Vol 12 (1) ◽

pp. 101

Author(s):

Augusto Pereira ◽

Manuel Herrero-Trujillano ◽

Gema Vaquero ◽

Lucia Fuentes ◽

Sofia Gonzalez ◽

...

Keyword(s):

Pelvic Pain ◽

Conventional Therapy ◽

Chronic Pelvic Pain ◽

Myofascial Pain ◽

Visceral Pain ◽

University Hospital ◽

Common Symptom ◽

Rectal Pain ◽

Inferior Hypogastric Plexus ◽

Hypogastric Plexus

Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.

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Sensitivity and specificity of clinical findings for the diagnosis of pelvic congestion syndrome in women with chronic pelvic pain

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517702057 ◽

2017 ◽

Vol 33 (5) ◽

pp. 303-308 ◽

Cited By ~ 5

Author(s):

Ana Lucia Herrera-Betancourt ◽

Juan Diego Villegas-Echeverri ◽

Jose Duván López-Jaramillo ◽

Jorge Darío López-Isanoa ◽

Jorge Mario Estrada-Alvarez

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Diagnostic Performance ◽

Abdominal Mass ◽

Clinical Score ◽

Trigger Points ◽

Clinical Findings ◽

Diagnostic Tools ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

Background Pelvic congestion syndrome is among the causes of pelvic pain. One of the diagnostic tools is pelvic venography using Beard’s criteria, which are 91% sensitive and 80% specific for this syndrome. Objective To assess the diagnostic performance of the clinical findings in women diagnosed with pelvic congestion syndrome coming to a Level III institution. Methods Descriptive retrospective study in women with chronic pelvic pain taken to transuterine pelvic venography at the Advanced Gynecological Laparoscopy and Pelvic Pain Unit of Clinica Comfamiliar, between August 2008 and December 2011, analyzing social, demographic, and clinical variables. Results A total of 132 patients with a mean age of 33.9 years. Dysmenorrhea, ovarian points, and vulvar varices have a sensitivity greater than 80%, and the presence of leukorrhea, vaginal mass sensation, the finding of an abdominal mass, abdominal trigger points, and positive pinprick test have a specificity greater than 80% when compared with venography. Conclusion This study may be considered as the first to evaluate the diagnostic performance of the clinical findings associated with pelvic congestion syndrome in a sample of the Colombian population. In the future, these findings may be used to create a clinical score for the diagnosis of this condition.

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Frequency and Clinical Manifestations of Caesarean Section Scar Defects

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd9-1/013 ◽

2020 ◽

Author(s):

Ome Kulsoom

Keyword(s):

Pelvic Pain ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Cross Sectional Study ◽

University Hospital ◽

Menstrual Irregularity ◽

Chi Square ◽

Cross Sectional ◽

Caesarean Scar ◽

Caesarean Scar Defect

Background: Caesarean Sections (CS), significantly on the rise worldwide, have been found frequently complicated with the presence of a scar at the site of CS. It is associated with various gynecological problems like postmenstrual spotting, infertility, miscarriage, and uterine rupture. The objective of this study was to determine the frequency of CS scar defects and associated gynaecological symptoms. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Ziauddin University Hospital Karachi from October 1st, 2017 to March 1st, 2018. A total of 162 patients’ (aged 20-40 years) were included, with CS history (elective or emergency) and complaints of chronic pelvic pain, infertility or menstrual irregularities, after an informed consent. Demographic details and medical history were recorded on performa. Chi-square was used to establish association between categorical variable such presence of scar defect, clinical symptoms and the shape of the defect. Results: Out of 162 patients, 86(53.1%) had one and 76(46.9%) had more than one caesarean scar. Majority of the patients 97(59.9%) were found to have scar defect (NICHE) present while in 65 (40.1%) patients had no caesarean scar defect. Regarding menstrual cycle, 58(35.8%) had heavy bleeding, 39(24.1%) continuous bleeding, and 27 (16%) irregular cycle. Significant association (p˂0.05) was found between menstrual irregularity, pelvic pain, infertility and scar defects. Different shapes of scar (niche) were noted triangular 46(28.4%) droplet 26(16%), oval and others such as rectangular and inclusion cyst on ultrasonographic . Conclusion: Multiple Caesarean sections are predisposing factors for Caesarean scar defects. Menstrual irregularity, pelvic pain, infertility and scar defects were found significantly associated with Caesarean sections (p˂0.05).

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Robson’s class and caesarean scar defects

10.36811/ijrmsh.2019.110001 ◽

2019 ◽

pp. 01-07

Author(s):

Carlo Alovisi ◽

Roberta Amadori ◽

Carlotta Alovisi ◽

Daniela Surico

Keyword(s):

Double Layer ◽

Single Layer ◽

Abnormal Uterine Bleeding ◽

Suture Technique ◽

Robson Classification ◽

Caesarean Scar ◽

Uterine Incision ◽

Class 1 ◽

Uterine Scar ◽

Caesarean Scar Defect

Caesarean scar defect (CSD) may lead to the occurrence of gynecologic symptoms such as abnormal uterine bleeding secondary to intermittent passage of retained menstrual blood within the CSD pelvic pain, and infertility. This prospective cohort study was conducted at the Department of Obstetrics at Maria Vittoria Hospital in Turin (Italy), from January 2013 to December 2013 to analyze the effects of two different suturing techniques (single layer and double layer closure of the hysterotomy) and Robson's class impact on the incidence of CSD. All procedures were performed using a modified Stark technique by the same single senior surgeon. The way of closure of the uterine incision was alternated every three months, in order to have two groups of partecipants: one with a single layer and the other with a double layer closure technique. Single layer was carried out as one continuous locking stitch; double layer was performed with a first closure identical to the single layer and an additional suture with a continuous unlocked stitch used to imbricate the first layer. Both ways of closure of the uterine incision were performed using monofilament synthetic absorbable polydioxanone suture. Twelve months after their caesarean section, the women had an ultrasound examination of the uterine scar performed by a single experienced operator blinded to suture technique and the Robson class. The trial recruited 85 cases. 21 patients (24.8%) belonged to Robson's class 1, 5(6%) to class 2, 1(1.3%) to class 4, 35(41%) to class 5, 13(15.4%) to class 6, 6(7%) to class 7, 4(4.5%) to class 8. During the ultrasound follow up we found 10 CSD (11,8%): 8/10 CSD (80%) were found in Robson's class 5, 1 in class 1 and 1 in class 6 (p 0.008), with no correlation with single- or double-layer suture (p 0.141). To our knowledge, no previous studies evaluated the correlation with Robson classification and CSD.

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ROLE OF LAPAROSCOPY IN CHRONIC PELVIC PAIN

10.36106/ijsr/8237105 ◽

2020 ◽

pp. 1-2

Author(s):

Priya Saxena ◽

Bharti Maheshwari ◽

Debarshi Jana

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Diagnostic Laparoscopy ◽

Proper Selection ◽

Medical College ◽

Common Causes ◽

Ideal Method ◽

Selection Of ◽

The Ideal

Background/purpose: The purpose of the present study was to evaluate the role of laparoscopy in diagnosis the cases of chronic pelvic pain. Methods: This prospective study was conducted among 100 women who had been suffering from chronic pelvic pain for ≥6 months at Department of Obstetrics & gynaecology, Muzaffarnagar Medical College, Muzaffarnagar from December 2017 to December 2018. After proper selection of cases, a detailed history followed by general, systemic and pelvic examination, diagnostic laparoscopy of the patient was done and noted as per the following protocol. Diagnostic laparoscopy was performed under general anaesthesia using a 5-mm Karl Stortz 30° angle double port laparoscope. The data was collected and subjected to statistical analysis using SPSS version 22.00 Results: Majority (70%) of patients with CPP were in the age group between 26 – 30 years and 31 – 35 years. Two most common causes of CPP detected clinically were endometriosis and chronic PID which together constituted about 56% of the cases with CPP in our study group. Laparoscopy findings revealed that 90% of patients with CPP have one or more positive findings, the commonest being endometriosis in various pelvic sites with or without endometrioma (34%) Conclusion: It can be concluded that ideally hysteroscopy should be performed simultaneously to identify intrauterine pathologies, which can be associated with CPP and which are missed by laparoscopy. Hence combined laparohysteroscopy is the ideal method for diagnosis of CPP.

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Adenomyosis at Hysterectomy: Prevalence, Patient Characteristics, Clinical Profile and Histopatholgical Findings

Kathmandu University Medical Journal ◽

10.3126/kumj.v10i1.6915 ◽

2012 ◽

Vol 10 (1) ◽

pp. 44-47 ◽

Cited By ~ 5

Author(s):

A Shrestha ◽

R Shrestha ◽

LB Sedhai ◽

U Pandit

Keyword(s):

Medical Therapy ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Histopathological Examination ◽

Menopausal Status ◽

Lower Abdominal Pain ◽

Abnormal Uterine Bleeding ◽

Clinical Findings ◽

Uterine Bleeding ◽

Clinical Profile

Background Underlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. Objective To find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. Methods A total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. Results A total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age- 45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. Conclusion Women undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy . KATHMANDU UNIVERSITY MEDICAL JOURNAL VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 53-56 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6915

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Chronic pelvic pain: Oral contraceptives and non-steroidal anti-inflammatory compounds

Cephalalgia ◽

10.1177/0333102497017s2009 ◽

1997 ◽

Vol 17 (20_suppl) ◽

pp. 29-31 ◽

Cited By ~ 4

Author(s):

Pl Venturini ◽

V Fasce ◽

F Gorlero ◽

G Ginocchio

Keyword(s):

Pelvic Pain ◽

Oral Contraceptives ◽

Chronic Pelvic Pain ◽

Gnrh Analogues ◽

Primary Dysmenorrhoea ◽

Common Causes ◽

Appropriate Therapy ◽

Inflammatory Drugs ◽

Anti Inflammatory

A correct classification of female pelvic pain originating from gynaecological disorders is essential if the most appropriate therapy is to be chosen. Certain types of non-steroidal anti-inflammatory drugs and oral contraceptives reduce the production of prostaglandins, which are responsible in large part for primary dysmenorrhoea. Oestroprogestin formulations become the drugs of choice if the patient also requests contraception. Secondary dysmenorrhoea and chronic pelvic pain may require combined medical and surgical treatment. Oral contraceptives can also be used as post-treatment agents in endometriosis, one of the most common causes of pelvic pain, whereas more specific compounds (GnRH-analogues and Danazol) are used to produce anatomical regression of endometriosis.

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