ROLE OF DIAGNOSTIC LAPAROSCOPY IN WOMEN WITH CHRONIC PELVIC PAIN

Abstract Aim: To evaluate causes of chronic pelvic pain (CPP) by diagnostic laparoscopy and to compare clinical findings with ultrasound and laparoscopic findings. Methods: Total 50 patients presenting with CPP to the gynaecological outpatient department were included in the study. After bimanual pelvic examination and routine investigations these patients were evaluated by ultrasonography (USG) followed by diagnostic laparoscopy in the postmenstrual period. Results: Clinical examination was able to pick up abnormalities in 23 cases (46%). However laparoscopy revealed pelvic pathology in 21 of the 27 cases found normal on clinical examination. Thus the sensitivity of clinical examination in diagnosing pelvic pathology was 52.27% vs laparoscopy. Similarly USG was able to pick up abnormalities in 27 cases (54%). All of these were confirmed on laparoscopy. However laparoscopy revealed pelvic pathology in 17 of the 23 cases found normal on USG. Thus the sensitivity of USG in diagnosing pelvic pathology was found to be 61.36% vs laparoscopy. Diagnostic laparoscopy was found to be significantly better in diagnosing the cause of chronic pelvic pain as compared to USG (p<0.001). Eighty eight percent cases revealed some or the other pelvic pathology on laparoscopy. Maximum cases (36%) were diagnosed as chronic pelvic inflammatory disease (PID) followed by endometriosis (26%), peri-tubal and peri-ovarian adhesions (16%), and ovarian cyst (10%). Three cases had fibroid uterus associated with chronic PID. All the 12% cases found normal on laparoscopy were also normal on pelvic examination and USG. Conclusions: Laparoscopy is the diagnostic modality of choice for evaluation of patients with chronic pelvic pain. It not only helps in diagnosing but also prognosticating the cases of pelvic adhesions and endometriosis where clinical examination and USG fail. Keywords: Chronic pelvic pain; USG; Laparoscopy; Bimanual pelvic examination