Authors: Ed D. Gabitoya, MD, Ma. Barbra A. Destajo, MD, ThessieMinelli Valdez, Rosella S. Arellano, MD, Marvin T. Tamaña, MD Philippine Heart Center
ABSTRACT Background Chronic pelvic pain secondary to pelvic varices remains a diagnostic and therapeutic challenge to most physicians involved in the management. Until the recent advancements, this condition is considered to be diagnosed and managed radiologically. Heightened awareness of the specific symptomatology and associated clinical findings as well as appropriate use of imaging modality may bring about a more rapid progression toward treatment and improved quality of life.
Case We are presented with a 25 year old, nulliparous female with chronic pelvic pain. After a long and laborious work up, she ended up having exploratory laparotomy and was found out to have pelvic varices at the left adnexal area. Further imaging with CT and MRI showed findings compatible with pelvic vein syndrome. She was referred to our institution for further management and underwent venography and subsequent pelvic vein embolization with immediate relief of symptoms. Discussion The major defect in pelvic congestion syndrome is the presence of reflux through the incompetent valves in the ovarian and pelvic veins. The clinical manifestations are varied and non-specific making the diagnosis of this condition challenging. Imaging like pelvic ultrasound, computed tomography and magnetic resonance imaging maybe necessary to confirm the presence of pelvic varices although, venography remains a reliable minimally invasive gold standard tool that provides immediate dynamic flow information and enable subsequent intervention if necessary. Pelvic vein embolotherapy is now accepted as the first choice option in the management of pelvic pain syndrome because of its promising results in terms of clinical success and its limited invasiveness.
Conclusion Pelvic congestion syndrome is associated with significant morbidity that affects quality of life. Awareness and clinical suspicion of the associated symptomatology and use of appropriate imaging modalities are essential in the early detection of this condition. Pelvic vein embolization is considered safe, effective and minimally invasive treatment option that restores patients to normal life.
Keywords: pelvic congestion syndrome, pelvic vein embolization, chronic pelvic pain, pelvic varices
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