Work

The Complexity of Diagnosing Pelvic Congestion Syndrome: An Insight into Symptom Diversity and Patient’s Journey to Diagnosis

Year: 2024

Type: article

Abstract: Pelvic congestion syndrome (PCS) is a vascular disorder primarily observed in premenopausal women, though not exclusively. Varicose veins in the pelvis, either multifactorial or as the result of compression syndromes, cause a buildup of blood leading to pressure and pain1. Although pelvic pain is the most common symptom, PCS can manifest through a plethora of nonspecific symptoms that may overlap with other pelvic conditions, making its clinical identification a challenge. The lack of standardized diagnostic criteria and varied symptomatology contribute to frequent misdiagnoses and prolonged suffering for patients. We performed a retrospective review of the medical records of 29 patients from June 2019 to June 2023. We collated information on the duration of symptoms, initial reasons for referral, characteristics of symptoms, referral provider specialty, and prior medical or surgical interventions. Of the 29 patients, 27 were female (93%), two were male (7%), with an average age of 42 years and a median age of 41 years. The data reveal a diverse range of symptomatic experiences: all 29 patients reported pelvic pain, four reported pelvic pain exacerbated during menstrual cycle (14%), 12 reported lower extremity symptoms (41%), six reported lower back pain (21%), and 10 reported pain associated with sitting or standing (34%). Symptom durations ranged from 6 months to as long as 20 years (average, 7; median, 6). Of the 29 patients, 11 were referred from vascular surgery (38%), seven were self-referral (24%), five were referred from obstetrics and gynecology (17%), two from neurology/pain management (7%), one from family medicine (3%), one from urology (3%), and one from interventional radiology (3%). Additionally, their medical histories revealed a range of previous interventions. Eight patients had a history of venous procedures, including venograms, venous stripping, and venous embolization. Five patients had a history of C-sections, and four had undergone hysterectomies. Other gynecological procedures include interventions like vaginectomy and endometrial ablation for endometriosis. The diversity and nonspecific nature of symptoms linked to PCS point to an urgent need for improved clinical recognition and education on this syndrome. The prolonged duration of symptoms experienced by many, often leading to multiple referrals across specialties, further emphasizes the imperative for diagnostic clarity. Strengthened multidisciplinary collaboration and increased education among health care professionals can facilitate swifter identification and management of PCS. By refining diagnostic pathways and fostering a more comprehensive understanding of the condition, we can ensure that patients receive appropriate, timely interventions, ultimately improving their quality of life and minimizing medical costs associated with misdiagnosis and unnecessary treatments.

Source: Journal of Vascular Surgery Venous and Lymphatic Disorders

DOI: 10.1016/j.jvsv.2024.101800

Authors: Jack Lin, Chloe Issa Zoe Miller

Institution: University of Miami

Language: English

Topic: Diagnosis and Treatment of Venous Diseases

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,100