Large bowel-to-pelvic sidewall adhesions associated with chronic pelvic pain

Study Objectives. To assess retrospectively the prevalence of colon-to-pelvic sidewall adhesions associated with pelvic pain or pelvic endometriosis, and to evaluate prospectively their prevalence compared with controls. Design. A retrospective review of all patients undergoing laparoscopy for chronic pelvic pain between August 1992 and September 1993; and based on a power analysis, a prospective comparison of women undergoing laparoscopy for chronic pelvic pain with those undergoing laparoscopy for tubal sterilization between October 1994 and December 1995. Setting. A university-associated teaching hospital. Patients. Fifty women in the retrospective portion, and 30 women (15 in each group) in the prospective portion. Measurements and Main Results. Of the 50 women undergoing laparoscopy for pelvic pain, 47 (94%) had either right- or left-sided colon-to-sidewall adhesions, and these adhesions were more common than any other type of intraabdominal adhesion, 94% versus 58%. Thirty-eight (76%) of these women had visual and 25 (50%) histologic evidence of endometriosis. The prospective study revealed that women with pelvic pain had a higher rate of colon-to-sidewall adhesions than controls (93.3% vs 13.3%) and a correspondingly higher rate of visualized endometriosis (73.3% vs 6.7%). Right-sided paracolic adhesions were both more common than left-sided adhesions (87.7% vs 46.7%) and were more often extensive than minimal (46.1% vs 6.7%). Conclusions. Colon-to-sidewall adhesions occur in the majority of patients with chronic pain, whereas they are an uncommon finding in the general population. The lateral gutters are dependent regions of the abdominal cavity that are susceptible to the spread of peritoneal endometriosis or other inflammatory processes, and should be evaluated at diagnostic laparoscopy for chronic pelvic pain.