A terrifying report emerged from CBC News in Canada dated 11 March 2022. The report contains details of a court case where a Dr Andrew Kotaska is alleged to have removed both fallopian tubes from a lady being operated on for “Pelvic Congestion Syndrome”.
Pelvic Congestion syndrome (PCS) is a condition caused by problems with the veins in the pelvis. It can be thought of as “varicose veins of the pelvis”.
The most common cause is of pelvic vein reflux is when the valves do not work in the ovarian and internal iliac veins. This leads to blood falling the wrong way down the veins and accumulating in the pelvis. This accumulation of blood causes the pelvic veins to dilate. This in turn causes discomfort in the pelvis, lower abdomen, back and sometimes hips. It can also cause varicose veins of the legs, vulva and vagina.
Less commonly, a narrowing of the vein by external pressure can cause back pressure on the pelvic veins. This can also cause the same sort of dilation of the pelvic veins. Such conditions, commonly called “Nutcracker Syndrome” or “May Thurner Syndrome” depending on which veins are involved.
However, regardless of whether the problem is venous reflux or compression, the treatment is of the veins. Although some doctors do not understand veins well, they will recommend a hysterectomy for Pelvic Congestion Syndrome, presumably because it removes some of the varicose veins surrounding the womb. Removal of one or both fallopian tubes by themselves doesn’t make any sense at all.
Indeed, in the 22 years we have been treating Pelvic Congestion Syndrome, we have seen many patients who have previously had a hysterectomy and still have the symptoms of Pelvic Congestion because they still have remaining pelvic varicose veins.
Hence one can only hope that this article is misreporting the facts, and the doctor was actually trying to treat her for some other condition. If he was operating to try and stop Pelvic Congestion Syndrome, then the removal of either one or both fallopian tubes would not be expected to have any benefit to the patient at all.
When Pelvic Congestion Syndrome is suspected, the first line is to get a diagnosis by imaging the pelvic veins. Research from our clinic has shown the Transvaginal Duplex Ultrasound scan using the Holdstock-Harrison protocol appears to be the gold standard approach to this.
If Pelvic Congestion Syndrome is then confirmed, treatment is by coil embolisation of the veins under x-ray control, or rarely stenting veins. There is no need for any open surgery on the gynaecological organs for this condition.