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      Síndrome de congestión pélvica como causa de dolor pélvico crónico

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          Abstract

          El síndrome de Congestión Pélvica (SCP) es una causa reconocida de dolor pélvico crónico, el cual también se asocia a dispareunia y a varices a nivel vulvar. El flujo venoso retrógrado a través de venas pélvicas dilatadas y tortuosas secundarias a incompetencia valvular u obstrucción en las venas ováricas se ha considerado como la causa más probable. Se estima que el 60% de las pacientes con varices pélvicas son sintomáticas. La conexión directa con las venas arcuatas en el miometrio, el flujo de baja velocidad y el incremento del diámetro con la maniobra de Valsalva se asocian con la exacerbación de los síntomas. El tratamiento del SCP es aún controversial, pero la embolización endovenosa bilateral con escleroterapia ha reportado disminuir exitosamente los síntomas en la mayoría de los casos.

          Translated abstract

          Pelvic congestion syndrome is a reported cause of chronic pelvic pain, which is also associated with dyspareunia and vulvar varicosities. Retrograde flow through tortuous and dilated pelvic veins that develop secondary to incompetent valves or obstruction in the ovarian vein is considered the most likely cause. It is estimated that up to 60% of patients with pelvic varicosities are symptomatic. Imaging techniques demonstrate multiple dilated veins surrounding the pelvic organs. Direct connection to the arcuate veins in the myometrium, low velocity flow, and increase in diameter after the Valsalva maneuver all are associated with symptoms. The treatment of pelvic congestion syndrome remains controversial, but bilateral transcatheter embolization with sclerotherapy is reported to successfully improve symptoms in most cases.

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          Pelvic venous incompetence: reflux patterns and treatment results.

          To assess reflux patterns and the results of endovascular obliteration of ovarian veins in patients with symptomatic pelvic venous incompetence (PVI).
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            Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up.

            To evaluate the clinical results of embolisation of symptomatic, incompetent pelvic veins in women presenting with perineal veins.
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              Ultrasound evaluation of gynecologic causes of pelvic pain.

              Ultrasound should be considered the first-line imaging modality of choice in women presenting with acute or chronic pelvic pain of suspected gynecologic or obstetric origin because many, if not most, gynecologic/obstetric causes of pelvic pain are easily diagnosed on ultrasound examination. Since the clinical presentation of gynecologic causes of pelvic pain overlaps with gastrointestinal and genitourinary pathology, referral to CT or MRI, especially in pregnant patients, should be considered if the US examination is nondiagnostic. Copyright © 2011 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                mlcr
                Medicina Legal de Costa Rica
                Med. leg. Costa Rica
                Asociación Costarricense de Medicina Forense (Heredia )
                1409-0015
                December 2015
                : 32
                : 2
                : 129-137
                Affiliations
                [1 ] Universidad de Ciencias Médicas
                [2 ] Universidad de Costa Rica
                Article
                S1409-00152015000200014
                21fd3ddb-a533-4a65-bf66-00e7fa06b40c

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Costa Rica

                Self URI (journal page): http://www.scielo.sa.cr/scielo.php?script=sci_serial&pid=1409-0015&lng=en
                Categories
                Anatomy & Morphology
                Medicine, Legal

                Social law,Anatomy & Physiology
                pelvic pain,nutcracker syndrome,pelvic vein reflux,pelvic embolization,dolor pélvico,síndrome de Cascanueces,reflujo venoso pélvico,embolización pélvica,Congestión pélvica,Pelvic congestion

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