We present two cases of women with history of chronic pelvic pain (CPP) who underwent left ovarian vein coil embolisation for presumed pelvic congestion syndrome. Both women had previously had normal diagnostic laparoscopies prior to coil insertion. Both women continued to have pain despite embolisation and requested removal of coils. We illustrate the operative technique via video.

In the first case the pelvis displayed a bulky left ovary with tortuous left ovarian veins inferior to the coils. The coils had been partly extruded through the wall of the ovarian vein, lay adjacent to the sigmoid colon and left ureter at the level of the pelvic brim and were surrounded by adhesions. The coils extended from the level of the left fallopian tube superiorly to the mid paracolic gutter, and were able to be removed with the left ovary and its vascular pedicle.   There was no evidence of endometriosis either macroscopically or histologically via biopsies.

In the second case it was clear on inspection that the patient had widespread endometriosis, with deep deposits in the left pelvic side wall and uterosacral ligament, Pouch of Douglas and right paracolic gutter. These nodules were excised and endometriosis confirmed via histology. The coils were also readily visible through the wall of the ovarian vein and lying over the left iliopsoas and left ureter.

CPP is a common presentation in gynaecology and causative pathology is often missed.  Both the diagnosis of Pelvic Congestion Syndrome (PCS) and the use of coil embolisation to treat it are controversial. There are no systematic reviews published to show causation evidence between PCS and CPP. In addition, if causation were established there are no good quality primary randomised controlled trials to show that embolisation is effective. ^1,2,3

There is no precedent in the literature regarding laparoscopic removal of ovarian vein coils for this indication.

References:

1.       Tu FF, HahnD, Steege JF. Pelvic congestion syndrome-associated pelvic pain: a systematic review of diagnosis and management. Obstset Gynecol Surv 2010; 65(5):332-40

2.       Ball E, Khan KS, Meads C. Does pelvic congestion syndrome exist and can it be treated? Acta Obstet Gynecol Scand 2012; 91(5):525-528

3.       Roberton M, McCuaig R. Pelvic congestion syndrome. AJUM 2013; 16(1):26-29