Laparoscopy- reliable diagnostic & theraupeutic tool in management of pain abdomen of unknown etiology

Chronic pelvic & abdominal pain is persistent pain of greater than 6 months duration, debilitating ones daily activities. Patients with chronic abdominal Pain of unknown etiology are often subjected to a variety of procedures in an attempt to find a cause, simple investigations may give way to more complex and invasive ones in the pursuit to confirm diagnosis. We report a case of a patient aged 41yrs, with surgical history of LSCS twice with complaints of pain abdomen & pelvis presented to emergency department at night. Her history revealed on & off pain abdomen & pelvis for 2 years which was aggravated since 2months. A multidisciplinary team approach was given to her, she was attending pain management clinic & gastrosurgical unit, took multitude of tests along with upper & lower GI endoscopy of which nothing is conclusive & was interpreted as normal, simultaneously treated for UTI but with no permanent cure of her symptoms. Before taking up for laparoscopy we repeated surgical profile as well as USG abdomen & pelvis which was suggestive of normal study & CT scan was normal. Definite diagnosis preoperatively was not made hence we took her up after pain mapping & marking the site. Intraoperatively single large adhesion of omentum stuck from bowel to midline scar present which was the site she was referring to, multiple adhesions between the bowel & omentum stuck to left pelvic wall & adhesions in the right upper quadrant of the abdomen present, adhesiolysis done & anatomy was restored. Patient was pain free postoperatively & was completely asymptomatic in the follow up visits after 2 months. Purpose of presenting the paper is to stress the importance of laparoscopic approach for managing cases of chronic abdominal & pelvic pain of unknown etiology and to prepare an open broad minded multidisciplinary view of such cases at the same time reviewing available literature on it.