Chronic pelvic pain in women

• Main Authors: E. G. Grigoryev, D. V. Lebedeva, S. E. Grigoryev
• Format: Article
• Language: English
• Published: Siberian State Medical University (Tomsk) 2020-10-01
• Series: Bûlleten' Sibirskoj Mediciny
• Subjects: pelvic vein varicosity; pelvic vein congestion; radiologic diagnostics; endovascular occlusion; surgical treatment
• Online Access: https://bulletin.tomsk.ru/jour/article/view/2996

Chronic pelvic pain resulting from varicose veins of the small pelvis is a multidisciplinary problem. A key cause of pelvic congestion is congenital or acquired gonadal valve failure. Ultrasound and Doppler examination for chronic pelvic pain allows in most cases to diagnose pelvic varicose veins. Multispiral computed tomography or magnetic resonance imaging details the nature and extent of the pathology. Selective phlebography is considered the gold standard for diagnosing varicose veins of the small pelvis. Conservative treatment with phlebotropic drugs is prescribed for limited pelvic varicose veins. Surgical treatments include open resection and retroperitoneal and transperitoneal laparoscopic gonadal vein excision or clipping. The most effective is minimally invasive endovascular occlusion of reflux veins using spiral technologies and sclerosants. The left ovarian vein is reduced more often. The decision on bilateral embolization of blood vessels depends on the severity of changes in veins and the intensity of blood reflux. A decrease in the intensity or disappearance of pain in the pelvic area is achieved in 80–100% of cases after the procedure. Diagnosis of this condition is difficult due to the fact that the appearance of pelvic varicose veins is nonspecific and includes symptoms of surgical, urological, gynecological and other diseases of the pelvic organs.