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RMJ. 2013; 38(4): 397-400


Role of Laparoscopy in the diagnosis of chronic pelvic pain

Samina Rafiq Memon, Muhammad Rafique Memon, Altaf Ahmed Shaikh, Nailla Yousuf Memon.

Abstract
Chronic pelvic pain is defined as a noncyclic constant or intermittent pain of greater than six months duration and not completely relieved by medical treatment. It is one of the commonest symptomatology in gynaecological outpatient clinics. It accounts for 10% of office visits to gynaecologists and general clinics.1 Prevalence of chronic pelvic pain has been reported as 3.8% in women aged 15-73 years.2 In primary care practices, 39% of women complain of pelvic pain.3 The cause of pain is not always obvious as no pathology is seen in 40-60% of cases.4 Diagnostic laparoscopy is the gold standard to find out the underlying pathology. The aim of this study is to evaluate the cause of chronic pelvic pain in women on diagnostic laparoscopy. This Prospective descriptive study was conducted in Ghulam Mohammad Mahar medical college hospital and Hira medical centre sukkur, pakistan, during a period of last two years from May 2011 to April 2013. A total of 63 patients were selected for diagnostic laparoscopy, presenting with chronic pelvic pain for more than six months duration. Patients were selected from outpatient department of surgery, gynaecology and medicine. All the patients had a pelvic examination and pelvic ultrasonography as a routine baselines as well as C.T scan if indicated. Patients were evaluated completely for other causes of pain like gastrointestinal, urological and musculoskeletal, before laparoscopy was performed. Women with chronic pelvic pain and having pelvic pathological lesions detected on clinical and or ultrasound examination were excluded. Clinical, ultrasonographic and laparoscopic data was collected and analysed on SPSS version14. Chronic pelvic pain was observed more frequently in the age group between 26-35 years. Most of these women were married (90.47%) and nulliparous (50.79%). Majority of the patients presented with dull and sharp pain. On laparoscopic examination, pathological lesions were detected in 52(82.53%) patients while 11(17.46%) patients had negative laparoscopy and were re-evaluated for other causes of chronic pelvic pain. Out of 52 positive laparoscopies, tuberculosis was found in 17(26.98%) patients, pelvic inflammatory disease (PID)in 13(20.63%) patients, endometriosis in 09(14.28%) patients, pelvic adhesions in 06(9.52%) patients, benign ovarian cysts in 05(7.93%) patients and polycystic ovarian disease in 02(3.17%) patients. Laparoscopy is a useful diagnostic tool for women with chronic pelvic pain and can be used as a guideline for individualized treatment.

Key words: Diagnostic laparoscopy, chronic pelvic pain, pelvic tuberculosis, endometriosis, P.I.D



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