Endometriosis and adhesions are the most common identified complication in laparoscopic evaluation of chronic pelvic pain.

Endometriosis

Endometriosis is diagnosed in 15 to 40 percent of patients who have laparoscopy due to chronic pelvic pain. As a result of mild inflammatory response by endometriosis, adhesions occur over time between the pelvic organs.

There is no relationship between the location of the disease and the symptoms of pain, as well as the severity of the pain and the stage of the disease.

30-50% of patients have no pain despite the stage of the disease. Similarly, 40-60% of patients experience pain without regard to the stage of the disease, penetration of endometriosis deep into the pelvis, involvement of the rectovaginal and intestinal septum, uterus and bladder, are associated with pain. Pelvic adhesions associated with endometriosis are associated with pelvic pain.

Prostaglandin and cytokine production may be responsible for the severe pain seen in some patients with mild disease.

Pain syndrome associated with endometriosis is a pain that does not respond well enough to medical and surgical treatment (especially in minor and mild cases).

Adhesion

The adhesions observed during laparoscopy are often located in the same part of the abdomen where the pelvic pain is located. However, neither specific site (adnexal structures, wall or visceral, or intestinal peritoneum) nor adhesion density are associated with pain-related symptoms.

Diagnosis

Diagnostic laparoscopy is recommended if the causes of pain and the negative outcome of psychological assessment are ruled out. Laparoscopy can use local anesthesia to perform “conscious pain surveying” to determine the location of specific adhesions associated with pelvic pain. Manipulation of pelvic and appendicular adhesions causes pelvic pain.

 

treatment

The causal role of adhesion in pelvic pain is unknown, and surgery can lead to greater adhesion and possibly organ damage, and abortion surgery and advanced cases of endometriosis that do not respond to medication. The causal role of adhesion in pelvic pain is unknown, and surgery can lead to greater adhesion and possibly organ damage, and abortion surgery and advanced cases of endometriosis that do not respond to medication.

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