Diagnostic laparoscopy in chronic pelvic pain

Damyanti Sharma, Krishna Dahiya, Nirmala Duhan, Ruchi Bansal
Archives of gynecology and obstetrics · 2010 · vol. 283(2) , pp. 295–297 · doi:10.1007/s00404-010-1354-z · PMID:20072784 · W2022469389
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

This study evaluated 50 women with chronic pelvic pain using laparoscopy, finding adhesions, endometriosis, and pelvic congestion as common causes, with laparoscopy showing higher diagnostic accuracy than clinical or ultrasonographic methods.

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This prospective study evaluated causes of chronic pelvic pain in 50 women by performing diagnostic laparoscopy after detailed history, examination, investigations, and ultrasonography, and then compared pelvic examination and ultrasound findings against laparoscopy as the reference (“gold standard”). The most common laparoscopic findings were adhesions (40%), endometriosis (18%), and pelvic congestion syndrome (20%), with 10% having a normal pelvis. The authors reported very low sensitivity for clinical examination (8.1%) and ultrasonography (2%) in detecting the underlying pathology. Relevance to endometriosis: endometriosis was directly identified as a laparoscopic cause of chronic pelvic pain (18% of cases), though the paper’s main focus is diagnostic laparoscopy for chronic pelvic pain overall rather than adenomyosis.

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Abstract

Introduction Laparoscopy, because of its availability and safety, provides a valuable tool in the evaluation of undiagnosed chronic pelvic pain. It is a simple and definitive means of establishing the presence or absence of pelvic pathology without resorting to major abdominal surgery.

Objective

To evaluate the causes of chronic pelvic pain using laparoscopy and to correlate between clinical examination, ultrasonography, and laparoscopy.

Material and methods

The present prospective study was done in the Department of Obstetrics and Gynecology of Pt. BD Sharma, PGIMS Rohtak. Fifty cases of chronic pelvic pain attending gynae OPD were included in the study. After detailed history, examination, investigations, and ultrasonography, the patients were subjected to laparoscopy.

Results

The mean age and parity of the patients with CPP was 30.88 ± 7.71 years and 1.74 ± 1.38, respectively. The mean duration of pain was 2.8 years (6 months–8 years). The commonest finding on laparoscopy was adhesions in 40%, endometriosis in 18%, and pelvic congestion syndrome in 20%, while 10% of the patients had normal pelvis. Laparoscopic findings were taken as gold standard and pelvic examination and ultrasonographic findings were compared with it.

Conclusion

Clinical examination and ultrasonography has a sensitivity of 8.1 and 2%, respectively. Laparoscopy helps in detecting many causes of CPP which clinical methods and ultrasonography fail to identify. This enforces the position of laparoscopy as a gold standard in evaluation of this condition. Similar content being viewed by others

References

Howard FM (1993) The role of laparoscopy in chronic pelvic pain: promise and pitfall. Obstet Gynecol Surv 48:357–387 Zondervan KT, Yudkin PL, Vessey MP (1999) Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol 106:1149–1155 Newham AP, VanderSpuy ZM, Nugent F (1996) Laparoscopic findings in women with chronic pelvic pain. S Afr Med J 86:1200–1203 Mara M, Fucikova Z, Kuzel D (2002) Laparoscopy in chronic pelvic pain—a retrospective clinical study. Ceska Gynekol 67:38–46 Howard FM (1993) The role of laparoscopy in chronic pelvic pain; the promises & pitfalls. Obstet Gynecol Surv 106:49–55 Kresch AJ, Seifer DB, Sachs LB (1984) Laparoscopy in 100 women with chronic pelvic pain. Obstet Gynecol 64:672–674 Goldstein DP, Decholnoky C, Emans SJ (1980) Laparoscopy in the diagnosis and management in pelvic pain in adolescents. J Reprod Med 24:251–256 Kamilya G, Mukherji J, Gayen A (2005) Different methods for evaluation of chronic pelvic pain. J Obstet Gynecol India 55:251–253 Sebanti G, Sarathi CP (2008) Laparoscopy in chronic pelvic pain. J Obstet Gynecol India 58:435–437 Hebbar S, Chawla C (2005) Role of laparoscopy in evaluation of chronic pelvic pain. J Min Access Surg 116–120 Nezhat FR, Crystal RA, Nezhat CH, Nezhat CR (2000) Laparoscopic adhesiolysis and relief of chronic pelvic pain. JSLS 4:281–285 Dwarakanath LS, Persad PS, Khan KS (1998) Role of laparoscopy in the management of chronic pelvic pain. Hosp Med 59:627–631 Howard FM (2000) The role of laparoscopy as a diagnostic tool in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynecol 14:467–494 Howard FM, El-Minawi AM, Sanchez RA (2000) Conscious pain mapping by laparoscopy in women with chronic pelvic pain. Obstet Gynecol 96:934–939 Neis KJ, Neis F (2009) Chronic pelvic pain: cause, diagnosis and therapy from a gynecologist’s and an endoscopist’s point of view. Gynecol Endocrinol 25(11):757–761 Richardson WS, Stefanidis S, Chang L, Earle DB, Fanelli RD (2009) The role of diagnostic laparoscopy for chronic abdominal condition: an evidence-based review. Surg Endosc 23(9):2073–2077 Duleba AJ, Keltz MD, Olive DL (1996) Evaluation and management of chronic pelvic pain. J Am Assoc Gynecol Laparosc 3(2):205–227 Conflict of interest statement None. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Sharma, D., Dahiya, K., Duhan, N. et al. Diagnostic laparoscopy in chronic pelvic pain. Arch Gynecol Obstet 283, 295–297 (2011). https://doi.org/10.1007/s00404-010-1354-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-010-1354-z

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Condition tags

mesh:D017699chronic_pelvic_pain

MeSH descriptors

Genital Diseases, Female Laparoscopy Pelvic Pain Adult Chronic Disease Female Genital Diseases, Female Genital Diseases, Female Humans Pelvic Pain Sensitivity and Specificity Tissue Adhesions Tissue Adhesions Tissue Adhesions Ultrasonography

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