A Case of Pelvic Congestion Syndrome Successfully Managed with Keishibukuryogan

Abstract

Pelvic congestion syndrome is a condition in women caused by congestion or varicosity of the intrapelvic vein. We report a case of pelvic congestion syndrome managed with keishibukuryogan. The syndrome was diagnosed based on expansion of the left periuterine and ovarian veins.
A 61-year-old female presented to our clinic with left lower abdominal pain. NRS was 9 and Terasawa's oketsu score was 40, indicating marked blood stasis. A CT scan revealed vascular expansion (10 mm) of the left ovarian vein. Transvaginal ultrasonography also revealed vascular expansion (6.0 mm) of the left periuterine vein. Based on these findings, a diagnosis of pelvic congestion syndrome was established. She was treated with keishibukuryogan (7.5 g/day). NRS was improved to 1 and Terasawa's oketsu score was improved to 20. The symptoms were resolved within 6 months, and the medication was discontinued.
Three months after discontinuation, she presented to our clinic again with left lower abdominal pain. The medication was resumed and the symptom was improved. After 5 months, a contrast enhanced CT scan showed no change of vascular expansion of the left ovarian vein (from 10 to 9 mm). Keishibukuryogan treatment has now been continued for 10 months.