In Reply to: Re: Case 1001-02 -- Embolization for Pelvic Congestion Syndrome after Hysterectomy and Bilateral Salpingo-Oophorectomy posted by Moni Stein on October 07, 2001 at 18:37:05:
This is a great case. In patients with chronic pelvic pain from pelvic congestion syndrome hysterectomy and bilateral oophorectomy is not 100% curative. Beard [1] reported a series of 36 women of which 12 had persistent symptoms at one year and one woman whose symptoms affected her daily life. Therefore, it is likely that this woman had pelvic congestion syndrome that did not respond to hysterectomy and bilateral oophorectomy. The fact that she has responded to the ovarian embolization suggests that the benefit of hysterectomy and oophorectomy, ligation of the ovarian veins and anterior iliac venous plexus, was not effective and that she required occlusion of the entire ovarian vein for relief of her symptoms.
Cross sectional imaging is not especially helpful in the diagnosis of pelvic congestion syndrome. Rozenblit has described the presence of dilated ovarian veins on CT [2] in asymptomatic parous women. The finding of delayed empting of these abnormally dilated veins is necessary for the diagnosis of pelvic congestion syndrome. This functional information is not easily obtained from cross-sectional imaging.
We are using pelvic venograms [3] to evaluate women with chronic pelvic pain and suspicion of pelvic congestion syndrome. The 20 degree reverse Trendelenburg venograms demonstrate slight increases in the size of the internal iliac veins. However, the supine studies have been grossly abnormal in terms of dilated veins, contrast transit time, and degree of congestion of the ovarian venous plexus.
1. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. Beard RW; Kennedy RG; Gangar KF; Stones RW; Rogers V; Reginald PW; Anderson M. Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, London. Br J Obstet Gynaecol 1991 Oct;98(10):988-92.
2. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES Jr. Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467, USA. AJR Am J Roentgenol 2001 Jan;176(1):119-22
3. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Beard RW; Highman JH; Pearce S; Reginald PW. Lancet 1984 Oct 27;2(8409):946-9.