Syeda Shaista Waheed, Naeem Dilawar Kazmi, Tahir Siddique.
Comparison Between Clinical Diagnosis and Laparoscopic Findings of Chronic Pelvic Pain in an Experimental Study.
Ann Pak Inst Med Sci Jan ;12(4):195-8.

Objective: To describe the various causes of chronic pelvic pain as observed on laparoscopy and to compare the clinical diagnosis with the laparoscopic diagnosis. Study Design: It was a descriptive study conducted in Department of Obstetrics and Gynaecology, Hussain Memorial Hospital, Multan Road Lahore from December 2014-November 2015. Materials and Methods: Fifty patients who presented in gynaecology outpatient clinic with non-cyclic lower abdominal pain and fulfilling the inclusion criteria were selected for study irrespective of age and parity. All laparoscopies were performed on day case basis. After informed consent, the detailed history was taken from the patients. Physical examination was done regarding chronic pelvic pain. A clinical diagnosis was established. Diagnostic laparoscopy was performed later on these patients. The different causes of chronic pelvic pain were described as observed on laparoscopy. The comparison was made with clinical diagnosis. Results: Among the fifty patients in whom diagnostic laparoscopy for chronic pelvic pain was performed, clinical diagnosis of endometriosis was made in 25 cases (50%) but was confirmed laparoscopically in 22 cases (44%).pelvic inflammatory disease was suspected as the cause of chronic pelvic pain clinically in 18 cases (36%) but confirmed in 15 (30%). In these patients, multiple adhesions were found. Adhesions due to previous surgery were suspected clinically in 1 case (2%) while it was found laparoscopically in 2 cases (4%). 4 cases (8%) were suspected to have an ovarian cyst but laparoscopically it was seen in 5 cases (10%). Anomalies of the genital tract were diagnosed clinically in 2 cases (4%) but confirmed in only 1 case (2%) laparoscopically. Conclusions: Chronic pelvic pain is a common problem of women especially of reproductive age group. Thorough clinical evaluation should be undertaken to identify the patients needing a laparoscopy. Laparoscopy performed as a diagnostic tool will help provide patients, treatment without delay. It also helps to remove the disease as much as possible. This approach avoids the development of complications due to advance disease process. Proper clinical evaluation including careful history and detailed physical examination avoids unnecessary laparoscopies as well.

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