Deflecting sigmoid adhesions: an anatomic cause of chronic pelvic pain and irritable bowel syndrome

Background: The sigmoid colon is often attached to the pelvic sidewall through filamentous and fibrous adhesions. Although these tissue attachments are considered normal, they often can deflect the course of the colon as it enters the pelvis, which might cause symptoms. Objective: To evaluate the possible relationship between deflecting sigmoid adhesions, chronic pelvic pain, and gastrointestinal symptoms. Methods: One hundred forty-six women were evaluated at laparoscopy for chronic pelvic pain. Sigmoid attachments were graded by degree of deflection (1 = mild, 2 = moderate, 3 = severe) and cut to return the bowel to a position of minimal deflection. Results: Thirty-eight percent of patients had deflecting sigmoid adhesions, often in association with endometriosis. However, deflecting sigmoid adhesions were the only abnormality found in 23% of cases, and 80% of these women reported significant reduction in symptoms at 6-, 12-, and 18-month follow-up. Several of these women were referred because of failed treatment for irritable bowel syndrome. Women with endometriosis reported more gastrointestinal symptoms when a deflecting sigmoid adhesion also was present. Conclusion: Deflecting sigmoid adhesions were common in this group of women with chronic pelvic pain and frequently were associated with gastrointestinal symptoms. Further investigation of this entity is warranted.