An often-overlookedfactor in pelvicpain: Pelvic congestion syndrome

This paper is a case report describing a 44-year-old postmenopausal woman with chronic pelvic pain lasting about nine months, in whom pelvic ultrasound showed a right adnexal heterogeneous mass and MRI outside the hospital suggested a teratoma while also noting bilateral dilatation of pelvic vascular structures. After surgery with frozen section confirming mature cystic teratoma, intraoperative findings showed highly dilated ovarian veins and congested, varicose pelvic vessels, interpreted as pelvic congestion syndrome explaining the patient’s bilateral pain despite the right-sided mass; the authors explicitly note that PCS was not included in preliminary diagnoses because PCS is rarely seen in menopause. The patient underwent hysterectomy and bilateral salpingo-oophorectomy and reported very low postoperative pain with no pain by postoperative day 21. This paper is centrally about endometriosis? No—specifically, it addresses pelvic congestion syndrome as an often-overlooked cause of chronic pelvic pain, and it relates to endometriosis because it emphasizes differential diagnosis of pelvic pain conditions that can mimic or coexist with endometriosis, even though endometriosis is not directly discussed.

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