Diagnostic laparoscopy in chronic pelvic pain: What are the issues in a resource poor country?

Background : In resource poor countries, the underlying diagnosis of the cause of chronic pelvic pain are unclear in many of the cases, because of the poor sophistication of the non-invasive investigation tools that are employed in making the diagnosis, and laparoscope is not available in many health facilities that manage gynaecological emergencies. A study of the role of diagnostic laparoscopy is necessary. Aim : To determine the role of diagnostic laparoscopy in management of chronic pelvic pain in a resource poor country. Method : A two year prospective, comparative study of 44 patients with chronic pelvic pain, who had initial diagnosis following non-invasive investigations (clinical/laboratory/ultrasound evaluation) and final diagnosis following laparoscopy, at Aminu Kano Teaching Hospital, Kano, Nigeria. The correlation of the initial diagnosis with final diagnosis (accuracy of initial diagnosis) was done using tests of validity. Results : The period incidence was 27.9% of all gynaecological diagnostic laparoscopy. The sensitivity of initial diagnosis for ectopic pregnancy was 60.0%, specificity 89.5%, positive predictive value (PPV) 81.8%, negative predictive value (NPV) 51.5%, and accuracy 59.1%. For chronic pelvic inflammatory disease, the sensitivity was 23.3%, specificity 70.3%, PPV 21.4%, NPV 86.7%, and accuracy 61.4%. For pelvic adhesions, sensitivity was 0.0%, specificity 100.0%, PPV 0.0%, NPV 84.1% and accuracy 84.1%, and for uterine fibroids, the sensitivity was 100%, specificity 100%, PPV 100%, NPV 100% and accuracy 100%. Conclusion : Diagnostic laparoscopy should be strongly considered as a primary evaluation tool in the management of chronic pelvic pain in resource poor countries. Keywords : Chronic pelvic pain, resource poor countries, initial diagnosis, final diagnosis, tests of validity