OP11.07: Transvaginal sonographic mapping of pelvic adhesions in women with chronic pelvic pain

To compare transvaginal sonography (TVS) with laparoscopy in the diagnosis of pelvic adhesions in patients with chronic pelvic pain (CPP). Twenty-two patients with CPP underwent TVS up to 7 days prior to laparoscopic surgery. An accurate mapping of adhesions was performed at sonographic examination and during laparoscopy. The mapping was based on a detailed list of locations which described the adhesions in terms of presence or absence on different sides of the ovaries and the uterus, and in the pouch of Douglas, on the bladder, rectum, bowels and utero-sacral and broad ligaments. Adhesions were evaluated by TVS with abdominal palpation and by the visualization of thin septa between organs. The laparoscopist was blind to the result of TVS adhesions mapping and performed during surgery an accurate description of the site of pelvic adhesions. Furthermore the site of adhesions was correlated with the type of pain referred by the patients (dyspaurenia, urinary urgency, back pain, dyschezia, etc). A correlation between TVS and laparoscopic findings was found. The concordance rates for ovarian adhesions with the uterus and the broad ligament were, respectively, 90% and 89%. Also for uterine adhesions within the peritoneum or the pouch of Douglas the diagnostic concordance was high (91%). Bowel adhesions to the ovaries or uterus can be suspected by the fixation and tenderness during palpation of the tissue surrounding the uterus and ovaries. Filmy adhesions between bowels and peritoneum were often overlooked, sensitivity being 34%. Non-invasive adhesion mapping by TVS in patients with CPP helps to explain the type of pain also.