Sonographic and laparoscopic findings in women presenting with chronic pelvic pain

Objective
The aim of this study was to assess the value of transvaginal ultrasound (TVS) examination in predicting the etiological factors of chronic pelvic pain (CPP) in comparison with laparoscopic findings.
Patients and methods
This is a prospective observational study. This study was conducted in Women Health Hospital, Assuit University. A total of 40 patients, 20 with CPP and 20 seeking for fertility as a control group, undergoing TVS before diagnostic laparoscopy were included in the study. TVS examination was performed. Ultrasound hard markers were documented (anatomical abnormalities – e.g. endometrioma or hydrosalpinx). The woman was then assessed for the presence or absence of ultrasound soft markers (reduced ovarian mobility, site-specific pelvic tenderness, and the presence of loculated peritoneal fluid in the pelvis). Then diagnostic laparoscopy was performed. Assessment of the value of TVS in predicting the etiological factors of CPP in comparison with laparoscopic findings was the main outcome measure.
Results
Laparoscopy diagnosed pathological lesions in 18 (90%) CPP patients, of whom 10 (55.5%) patients had endometriosis, 10 (55.5%) had pelvic adhesions, 1 (5.5%) had ovarian cyst, 3 (16.6%) had tubal block, and 1 (5.5%) had subserous fibroids. The diagnostic accuracy of ultrasound hard marker examination of CPP was 30%, which increased to 80% by the addition of ultrasound soft marker examination.
Conclusion
Inclusion of site-specific pelvic tenderness, ovarian mobility, and the presence of loculated peritoneal fluid in the pelvis as indirect ultrasound-based markers of pelvic pathology improved diagnostic accuracy of TVS and hence improved the detection and exclusion of significant pathology in women with CPP and may lead to a reduction in the number of unnecessary laparoscopies carried out on women with CPP.