[Painful pelvic adhesion syndrome]

Pelvic adhesions may be responsible for pelvic pain, at least partially, in the following conditions: sequelae of past infection, chronic active inflammatory state, endometriosis, post-operative adhesions. The problem in the presence of adhesions is to determine whether pain is mechanical, inflammatory and/or linked to associated ovarian dystrophy, and what is the psychological component. The postulate "adhesion = pain" is far from constant and there is no systematic relationship between clinical picture and anatomical findings. After careful clinical and laboratory evaluation, celioscopy is the key diagnostic procedure. It should include thorough examination of all pelvic organs, of the abdomen in general and the peri-hepatic region in particular. A diagnosis of psychosomatic pain can be made only in the absence of any macroscopic, histological and bacteriological lesion, though bearing in mind that this term certainly covers failure to recognise other causes.