Pelvic Congestion Syndrome without Venography: A Pragmatic Pathway Using Doppler Ultrasound, Laparoscopy and Ligation in Resource-Limited Settings |Chapter 5 | Medical Science: Updates and Prospects Vol. 3

 

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

Demystifying the Female Chronic Pelvic Pain | Chapter 7 | Disease and Health: Research Developments Vol. 10

Chronic pelvic pain is one of the debilitating conditions in women that causes pain in the abdominopelvic region and affects their reproductive years of life till the postmenopausal period. It causes many difficulties in women’s lives, from work life to their personal lives, affecting them negatively. The causes of CPP can be any pathological changes in the body, such as changes in reproductive organs, musculoskeletal changes, neurological changes, or changes in genitourinary organs. Treating the underlying condition resolves the CPP; however, sometimes it takes a long time to get resolved when the neuro-musculoskeletal system is involved. There are various diagnostic evaluation methods available that help in finding out the cause of CPP and managing it. For the management of CPP, several treatment options are available, such as physical therapy, medication, and surgical procedures. However, it has been discovered that physiotherapy plays a significant role in managing CPP and preventing its recurrence.

 

Author (s) Details

Rutuben Bhavsar
College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India.

 

Kritagya Malik|
Abhinav Bindra Targeting Center X Artemis Hospitals, Gurugram, Haryana, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrd/v10/5298

A Diagnostic Odyssey: Coccydynia Misdiagnosis and Its Tolls on Chronic Pelvic Pain | Chapter 13 | Advanced Concepts in Medicine and Medical Research Vol. 4

 This branch provides a itemized account of diagnostic complicatedness faced accompanying misdiagnosed coccydynia leading to chronic pelvic pain, accompanying a specific objective to influence medical literature and stressing the importance of early disease and early management to help patient outcomes and quality of existence. Coccydynia is a disabling condition from pain in the coccyx region of the backbone. Persistent discomfort in the perineal region, famous as chronic pelvic pain, typically ends longer than six months and can have either instinctive or somatic origins. It doesn't respond well to traditional painkillers. We report a case of a 42-period-old female agony from severe chronic pelvic pain for the prior 15 years, for that she had been prescribed diversified analgesics including opiates and she endured multiple surgeries without some relief. She was a misdiagnosed case of coccygeal break which generated chronic pelvic pain for the past 15 y, and when medicated with center of activity impar neurolysis gave her complete pain relief. Coccyx is a sensitive and mobile cartilage which is supported by the sacrococcygeal bond and has more chances of sprain. Trauma to the lower back due to body sticking while being seated can too cause chronic twist over the coccyx.  At her one-period follow-up, she had NRS 1/10 and was entirely pain-free.When making a differential diagnosis for incessant pelvic discomfort, especially in women who are fertile, coccydynia needs expected taken into report.

Author(s) Details:

Liaquat Ali,
Department of Anesthesiology, Intensive Care & Pain Management, Fauji Foundation Hospital Rawalpindi, Pakistan.

Sara Haider Malik,
Department of Anesthesiology, Intensive Care & Pain Management, Fauji Foundation Hospital Rawalpindi, Pakistan.

Khaleel Ahmed,
Department of Anesthesiology, Intensive Care & Pain Management, Fauji Foundation Hospital Rawalpindi, Pakistan.

Sana Nasir,
Department of Anesthesiology, Intensive Care & Pain Management, Fauji Foundation Hospital Rawalpindi, Pakistan.

Please see the link here: https://stm.bookpi.org/ACMMR-V4/article/view/12482