Chronic pelvic pain in women: comparative study between ultrasonography and laparoscopy as diagnostic tool

Rajani Rawat, Shikha Seth, Ramakant Rawat, Ruchika Garg, Sushil Kumar Shukla, Soniya Vishwakarma
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2014 · vol. 3(4) , pp. 998 · doi:10.5455/2320-1770.ijrcog20141224 · W2101933475
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This study compared ultrasonography and laparoscopy in 100 women with chronic pelvic pain, finding laparoscopy to be more effective in diagnosing conditions like pelvic inflammatory disease and endometriosis.

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This study enrolled 100 women with chronic pelvic pain, who underwent clinical examination followed by both ultrasonography and laparoscopic examination to compare diagnostic performance. The most common symptom was vaginal discharge (70%), with pelvic tenderness on exam in 60%, and the mean pain duration was 15.2 months among women aged 25–30 years. Ultrasonography identified chronic pelvic inflammatory disease in 43% of cases and endometriosis in 6%, while laparoscopy found chronic pelvic inflammatory disease in 47% and endometriosis in 11%, with 13% showing normal findings at laparoscopy; the authors concluded laparoscopy was more effective than ultrasonography as a diagnostic tool. Relevance to endometriosis: endometriosis was reported on both ultrasonography (6%) and laparoscopy (11%) in this comparative diagnostic study, though the paper’s main focus is comparing ultrasonography versus laparoscopy for chronic pelvic pain diagnosis.

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Abstract

Background: Chronic pelvic pain is a major cause of morbidity among the reproductive age group women. The study on patients of chronic pelvic pain aimed to compare the diagnostic accuracy of ultrasonography and laparoscopy in these patients Methods: The study was conducted on 100 patients of chronic pelvic pain attending the gynaecology outdoor and were subjected to thorough clinical examination followed by ultrasonography and laparoscopic examination. Results: Maximum number of cases of chronic pelvic pain belonged to 25-30 years, were parous with mean duration of pain of 15.2 months. The most common complaint was vaginal discharge (70%) followed by menstrual irregularity. On clinical examination, pelvic tenderness was observed in majority (60%) of cases. USG examination showed chronic pelvic inflammatory disease in 43% cases followed by myoma (8%), ovarian cyst (5%), endometriosis (6%), pelvic congestion (5%) and no abnormal pathology in 25% cases. On laparoscopic examination, chronic pelvic inflammatory disease was present in 47% cases followed by endometriosis (11%), pelvic congestion (8%), myoma (8%), adhesions (7%) while 13% cases showed normal findings. Conclusions: Laparoscopy is more effective than ultrasonography as a diagnostic tool in patients of chronic pelvic pain.
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Keywords

Chronic pelvic pain, Laparoscopy, Pelvic inflammatory disease, UltrasonographyAbstract

Background

Chronic pelvic pain is a major cause of morbidity among the reproductive age group women. The study on patients of chronic pelvic pain aimed to compare the diagnostic accuracy of ultrasonography and laparoscopy in these patients

Methods

The study was conducted on 100 patients of chronic pelvic pain attending the gynaecology outdoor and were subjected to thorough clinical examination followed by ultrasonography and laparoscopic examination.

Results

Maximum number of cases of chronic pelvic pain belonged to 25-30 years, were parous with mean duration of pain of 15.2 months. The most common complaint was vaginal discharge (70%) followed by menstrual irregularity. On clinical examination, pelvic tenderness was observed in majority (60%) of cases. USG examination showed chronic pelvic inflammatory disease in 43% cases followed by myoma (8%), ovarian cyst (5%), endometriosis (6%), pelvic congestion (5%) and no abnormal pathology in 25% cases. On laparoscopic examination, chronic pelvic inflammatory disease was present in 47% cases followed by endometriosis (11%), pelvic congestion (8%), myoma (8%), adhesions (7%) while 13% cases showed normal findings.

Conclusions

Laparoscopy is more effective than ultrasonography as a diagnostic tool in patients of chronic pelvic pain. Metrics

References

Reiter RC. Chronic pelvic pain. Clin Obstet Gynaecol. 1990;33:130-6. Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynaecol. 1993;48:357-87. Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol. 1999;106:1149-55. Magni G, Salmi A, Delco D, Coela A. Chronic pelvic pain and depression. Psychopathology. 1984;17:132. Rohatgi M. Pelvic pain. Indian J Obstet Gynaecol 1971;21:226. Goldstein DP, Decholnoky C, Emans SI. Laparoscopy in the diagnosis and management of pelvic pain in adolescents. J Reprod Med. 1980;24:251-6. Kamilya Gourishankar, Mukherji Joydev, Gayen Abhimanyu. Different methods for evaluation of chronic pelvic pain. J Obstet Gynaecol India. 2005 May/Jun;55(3):251-3. Kang SB, Ching HH, Lee JY, Chang YS. Impact of diagnostic laparoscopy on management of chronic pelvic pain. J Sing Endosc. 2007;21(6):916-9. Ozaksit G, Caglar T, Zorlu CG, Cobanoglu O, Cicek N, Batioglu S, et al. Chronic pelvic pain in adolescent women. Diagnostic laparoscopy and ultrasonography. J Reprod Med. 1995;40(7):500-2. Kontoravdis A, Chryssikropoulos A, Hassiakos D, Liapis A, Zourlas PA. The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain. Int J Obstet Gynaecol. 1996;52:243-8.

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endometriosischronic_pelvic_pain

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