A Case Of Chronic Pelvic Pain Due To May-Thurner Syndrome
Jones P. Thomas, MD, Karem C. Harth, MD.
University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Pelvic congestion syndrome (PCS) is a poorly understood entity that is often difficult to diagnose given the varied constellation of presenting symptoms. PCS is often linked to ovarian vein reflux, left renal vein compression (Nutcracker Syndrome), common iliac vein compression (May-Thurner Syndrome), or hormonal and pregnancy mediated changes to pelvic veins. Here we present the workup and treatment of a 23 year old female presenting with chronic pelvic pain. Evaluation with magnetic resonance venography, conventional venogram, and intra-vascular ultrasound revealed significant compression of the left common iliac vein (LCIV) by the overlying right common iliac artery (May-Thurner Syndrome) leading to pelvic congestion via internal iliac vein reflux. Deployment of a self expanding nitinol stent to the LCIV treated the extrinsic compression and resolved the internal iliac vein reflux. At one month follow up patient was found to have total resolution of pelvic pain. This case demonstrates that May-Thurner syndrome associated with internal iliac vein reflux and subsequent pelvic congestion syndrome should be considered in the work up of chronic pelvic pain and can be easily treated with good symptom resolution.
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