骨盤痛を伴う骨盤臓器脱症例に対し腹腔鏡下アプローチが有効であった1例

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  We present a case of pelvic organ prolapse associated with chronic pelvic pain, which was successfully treated with laparoscopic surgery. The patient was 64 years old (gravida 2, para 2). She underwent total abdominal hysterectomy and right adnexectomy for a hydatidiform mole at the age of 43. Ten years later, she sensed that the suture thread in the vaginal stump had broken off inside her lower abdomen. Pelvic pain then developed. Six months later, she developed pelvic organ prolapse and the pelvic pain increased. She first came to our department 20 years after hysterectomy. Pelvic Organ Prolapse Quantification was used to diagnose a stage II vaginal cystocele and vaginal vault prolapse. She had tenderness on the left side of the vaginal stump, as well as a urinary disorder. Therefore, we performed laparoscopic surgery to identify the cause of pain. There were dense adhesions between the left adnexa and pelvic peritoneum. Furthermore, the threads of the vaginal stump were pulled tense. After left adnexectomy and resection of suture threads adherent to the pelvic peritoneum, her symptoms were markedly improved. She is doing well without recurrence 17 months after surgery. In cases of pelvic organ prolapse with unusual pelvic pain, a laparoscopic approach is effective.