Uterine adherence to the abdominal wall following caesarean section presenting as a cause of chronic pelvic pain - A cohort study

Background: The pathophysiology of chronic pelvic pain is not completely understood. Our aim was to present an unreported cause of chronic pelvic pain due to uterine adherence to the abdominal wall as a sequela of previous Caesarean section. Methods: The medical records of all women post-Caesarean section who were operated on in our department during the years 1999-2003 because of chronic pelvic pain, and who had been found to have uterine adherence to the abdominal wall, were reviewed. Sixteen (16) women diagnosed with this condition comprised the study cohort. A telephone survey was conducted to find out whether the surgery resolved the problem of chronic pelvic pain. Results: All of the study cohort patients complained of chronic pelvic pain lasting for at least 6 months. In 4 cases the uterus was enlarged (up to 18 weeks of gestation). In addition, foci of endometriosis (as well as endometrioma in one case) were found in 2 cases. Twelve (12) women underwent hysterectomies and became asymptomatic, while 4 women, who underwent conservative myomectomy, myomectomy with ovarian cystectomy, or ablative treatment for endometriosis, reported that they were still in pain. Conclusions: In the current study we present a previously unreported cause of chronic pelvic pain, appearing as a sequela of previous Caesarean section. Only the procedure of hysterectomy seems to provide a proper solution to the pelvic pain resulting from uterine adherence to the abdominal wall, although further studies should be performed to approve this hypothesis.