الفهرس 
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Abstract
Background: Chronic Pelvic Pain (CPP) is nonmenstrual pain of 6 months duration or longer that localizes to the anatomic pelvis and is severe enough to cause functional disability and require medical or surgical treatment. Laparoscopy, because of its availability and safety, provides a valuable tool in the evaluation of undiagnosed chronic pelvic pain. It is a simple and definitive means of establishing the presence or absence of pelvic pathology without resorting to major abdominal surgery and its main role is to diagnose endometriosis or adhesive disease However, the laparoscopic approach makes feasible not only the detection but also the treatment of the pelvic pain due to endometriosis and/or pelvic adhesions.
Objectives: The aim of this work is to evaluate the causes of undiagnosed chronic pelvic pain using laparoscopy.
Patients and methods: In the present study 100 women were included from those attending gynecological outpatient clinic with chronic pelvic pain who had taken treatment for pain with no relief for 6 months during the period from march2011 to February 2012. All patients were supjected to the following : Proper history taking,general and gynecological examination,laporatory invistigation, transvaginalsonography,and finally diagnostic laparoscopy under general anaesthesia. Laparoscopy is considered to be a useful diagnostic tool, providing positive findings in 90% in this study and offering some benefit, even when findings are negative because of its reassuring effect Laparoscopy allows surgeons to see and treat many abdominal conditions that could not be diagnosed otherwise.
Results: In the present study, there were high rates of pelvic adhesions as a cause(38%)and the majorty are due to previous surgery and are due to previous CS . In spite of the above, doubt has been cast as to how much pelvic adhesions could produce pelvic pain since the rate of adhesions found in women with infertility without pelvic pain was higher than that in patients with CPP. Pelvic endometriosis is one of the most common and most frequent causes of chronic pelvic pain in women. It has often been referred to as being able to mimic most all other causes of pelvic pain. However, laparoscopy is still considered the gold standard in the diagnosis of endometriosis.in the present study Other frequent findings were pelvic Congestion(10%)and hydrosalpinx(6%)and omental drag syndrome (4%)However, 10% of women had normal pelvic anatomy without definitive lesions suggesting chronic pelvic pain. In the group of patients with positive findings more than two-third of necessary operative interventions could be performed at the time of diagnosis in the present study including pelvic adhesiolysis, electrocauterisation of endometriotic nodules, uterosacral nerve ablation and ovarian cystectomy.
Conclusion, diagnostic laparoscopy is a gold standard diagnostic tool for women with chronic pelvic pain and can be used as a guideline for individualized treatment.