Introduction
Pelvic congestion syndrome is the development of dilated abnormal varicose veins within the pelvis causing pelvic pain. It is usually associated with leaking valves within the ovarian or pelvic veins. The symptoms vary between being very mild to quite severe and debilitating.
Causes
Pelvic congestion syndrome is associated with leaking or incompetent pelvic veins that lead to increase pressure and then congestion of the veins in the lower abdomen and pelvis. This causes engorgement of abnormal varicose veins that create pain. The reason that the valves become leaky is not clear. Similar to varicose veins a genetic predisposition is quite common.
Symptoms
Pelvic pain is the main feature. This is often influenced by hormonal changes. The symptoms are often difficult to separate from other pelvic inflammatory conditions such as endometriosis. The abnormal pelvic veins can also cause varicose veins to develop in the groin and down the back of the thighs.
Tests
Ultrasound scanning is used to evaluate the pelvic veins. Specifically, the left ovarian vein is the commonest culprit with leaking or incompetent valves identified. Usually that vein grows to 3-4 times normal size, with blood flowing in the wrong direction, towards the pelvis.
Diagnosis
Clinical suspicion based on the type of pain in addition to ultrasound scan results is the best way for a diagnosis to be made. CT venogram studies are used if an ultrasound is unclear or uncertain.
Treatment
The aim of treatment is to block the abnormal flow through the ovarian vein. It is not possible to repair the valves within the vein and the vessel is either ligated surgically or more commonly treated with endovascular embolisation.
Embolisation involves keyhole type surgery to block the abnormal vein from the inside by placing a series of embolisation coils into the vein that will occlude it and prevent abnormal flow. This is done under x-ray guidance through a small puncture in the right groin.