Principes généraux de la prise en charge diagnostique des douleurs pelvipérinéales chroniques postopératoires

IntroductionChronic postoperative pain has been defined as pain arising after a surgical operation, present for at least 2 months, with no organic (active cancer or chronic infection) or pre-existing cause. The purpose of this article is to review the aetiological and diagnostic assessment of chronic postoperative pelvic and perineal pain.Material and methodsA review of the literature was performed by searching PUBMED for articles on the diagnostic approach to chronic postoperative pelvic and perineal pain.ResultsThe chronology of the symptoms, i.e., rapid onset of pain following a surgical procedure that does not subsequently resolve, is a leading argument to incriminate the surgical procedure in the pathogenesis of the pain. Clinical examination of the scars and detailed analysis of the topography and type of pain are essential elements in the analysis of this pain. The primary objective of complementary investigations (imaging, EMG, etc.) is to eliminate a differential diagnosis, as they are normal in the case of chronic postoperative pain. A test block of a nerve or trigger point is the main test performed to determine the level of the lesion responsible for pain.ConclusionThe aetiological and diagnostic assessment of chronic postoperative pelvic and perineal pain requires a detailed clinical analysis based on examination of the scars and analysis of the clinical signs of muscle and nerve lesions. A local test block confirms the level of the lesion.