Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

12. Chronic Pelvic Pain in Women
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Fig. 12.4. Fibrotic cecal nodule with proven endometriosis (obliterated
appendix).
also be unremarkable. Patients with progressively worsening pain complaints
who are often refractory to first-line agents raise a diagnostic
flare. This process is often aided by simple measures such as transvaginal
ultrasound (TVUS) . TVUS is used to evaluate for ovarian or the
occasional bladder infiltrative disease, which is clinically useful because
treatment options, to be discussed later, would then differ. Pelvic exam
is a relatively poor predictor for DIE, but TVUS is consistently more
effective than more sophisticated and expensive tools such as MRI [ 11 ].
Surgery with histopathologic confirmation has been the historical gold
standard for diagnosing endometriosis; however, treatment can be initiated
based on clinical suspicion alone without visual confirmation.
Traditional first- line therapies used to manage pain from endometriosis
include pharmacological agents that suppress endogenous steroid
hormone production [ 12 – 15 ]. Table 12.2 provides a summary of medical
options.
Most operative strategies used to treat women with symptomatic
endometriosis focus on conservative measures designed to preserve
reproductive options. Hysterectomy with bilateral adnexectomy and
excision of infiltrating disease, however, may have the potential to
eliminate pain in women with refractory symptoms [ 16 ]. Any therapy
short of hysterectomy predisposes women to recurrent symptoms.
Laparoscopic ablation or excision of endometriotic lesions has been
evaluated in a number of clinical trials, with up to 80 % of women