Pelvic Congestion Syndrome and Medical Wandering about a Case: Literature Review

Pelvic varicose veins are a recurring cause of chronic pelvic pain. The heterogeneity of the symptoms can be the cause of a real medical wandering. Like any chronic painful syndrome, if untreated, pelvic congestion syndrome (PCS) can degrade patients’ quality of life through psychiatric disorders such as depression and anxiety. In addition, the PCS is therefore a diagnosis of exclusion, after all other causes have been eliminated. According to literature data, venography is the gold standard, but endovaginal ultrasound coupled with doppler is a good alternative. This case report describes a 42-year-old grand multiparous woman (G9P9009) presenting with chronic pelvic pain worsening with sexual intercourse. Initial examinations including a bimanual exam, infectious workup and endovaginal ultrasound revealed: a bacterial vaginosis, urogenital mycoplasma infections and a slight fluid collection in the Douglas pouch, but no other significant findings. The patient was treated with antibiotics and anti-inflammatories for presumed chronic pelvic disease. However, her pain persisted. A diagnostic laparoscopy, performed concurrently with a requested bilateral tubal ligation, revealed pelvic varicose veins. Ligation of these varicose veins associated to venotonics treatment after the surgery resulted in a complete resolution of the patient’s pelvic pain and dyspareunia. Faced with the difficulties of technical platforms in our context, in the absence of venography and endovascular embolization, we highlight the diagnostic challenges associated with pelvic congestion syndrome (PCS) and advocate for laparoscopy as a valuable diagnostic and therapeutic tool, particularly in resource-limited settings.