Role of laparoscopy in the diagnosis of chronic pelvic pain

Introduction: Chronic pelvic pain (CPP) is noncyclic pain of 6 or more months' duration that localizes to the anatomical pelvis, anterior abdominal at or below the umbilicus, and the lumbosacral and is of sufficient severity to cause functional disability. Lower abdominal pain can be caused by chronic pelvic inflammatory disease, pelvic adhesions, certain ovarian cysts, pelvic vascular congestion, uterine fibroids, and adenomyosis, but pain arising from organs outside the pelvis may also radiate to the lower abdomen. Only 20%–25% of patients respond to conservative management. When such treatment fails, a diagnostic laparoscopy is usually performed. Aim: We aim to study the role of laparoscopy in the diagnosis of CPP. Objective: The objective was (1) to evaluate the causes of CPP by diagnostic laparoscopy and (2) to compare the clinical finding and ultrasound findings with laparoscopic findings. Materials and Methods: The present study includes fifty patients presented with lower abdominal pain of at least 6-month duration. A detailed history was taken about the pattern of the pain and its association with other problems. Gynecological examination included inspection of the vulva and perineum, speculum examination of the cervix and vagina, bimanual examination to assess the shape, size, direction, mobility of the uterus and adnexa, mass and tenderness of the urethra, vaginal fornix and cervical motion tenderness. The patients were further evaluated by ultrasound examination (transvaginal and abdominal) and diagnostic laparoscopy. Results: Most of the women were of the mean age group of 29.30 years. The pain was most commonly associated with dysmenorrhea in 76% of the patients. Nine patients out of 26 who showed normal findings on bimanual examination revealed abnormal findings on laparoscopy. Five patients out of 22 who showed normal findings on ultrasonography showed abnormal findings on laparoscopy. Conclusion: Laparoscopy is a gold standard tool in the evaluation of women with CPP because diagnosis and treatment can be done in the same sitting.