Background: Pelvic congestion syndrome (PCS) is an
under-recognised cause of chronic pelvic pain and a frequent driver of
diagnostic wandering, particularly in low- and middle-income countries (LMICs).
Recent adoption of the SVP (Symptoms-Varices-Pathophysiology) framework and
more structured imaging pathways can shorten time to diagnosis and treatment.
Objective: To illustrate an SVP-harmonised, resource-adapted
diagnostic–therapeutic pathway that resolves pain and ends diagnostic
wandering.
Case presentation: A 42-year-old grand multipara (G9P9009) with
>6-month non-cyclical pelvic pain and post-coital exacerbation underwent a
stepwise work-up. Transvaginal duplex ultrasonography (TVUS) was used as the
gatekeeper test; cross-sectional venous imaging and selective venography were
not available. Persistent symptoms and high clinical suspicion led to
diagnostic laparoscopy with planned concomitant intervention. Laparoscopy
revealed parauterine varicosities consistent with venous reflux phenotype.
Transperitoneal ligation of the culprit veins was performed in the same
session. A venoactive agent was prescribed post-operatively for 30 days. The
patient experienced complete resolution of pelvic pain and dyspareunia on
follow-up, effectively terminating a prolonged diagnostic odyssey.
Conclusion: In settings where venography and endovascular
therapy are limited, a graded pathway SVP-guided clinical phenotyping,
standardised TVUS, and diagnostic-therapeutic laparoscopy is a pragmatic
alternative that can deliver rapid, patient-centred benefit. Embolisation remains
first-line where available; laparoscopy is a viable “when necessary” option.
Prospective LMIC studies with harmonised outcomes are urgently needed.
Author(s) Details
Michèle Florence
Mendoua
Department of Surgery and Specialties, Faculty of Medicine and
Pharmaceutical Sciences, University of Douala, Cameroon.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v3/6538
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