Frozen pelvis

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Abstract

Frozen pelvis is an informal medical term used in medical practice to describe a condition where the pelvic organs are extensively bound together by adhesions, resulting in significant disruption of their function and anatomy. Surgical treatment of this condition is challenging, even for experienced surgeons, because of the complexity of the adhesion process and resulting anatomical changes. The most common cause of frozen pelvis in gynecology is deep infiltrating endometriosis, which involves a complex interaction between inflammatory processes, tissue damage, impaired healing mechanisms, and neovascularization. The primary goal of surgical intervention is to remove adhesions, restore the pelvic anatomy, and alleviate symptoms. Successful treatment typically requires a multidisciplinary approach involving gynecologists, colorectal surgeons, urologists, and reproductive physicians to ensure optimal patient management and outcomes.

After reviewing the available literature, we found that there is a lack of domestic scientific publications on this pathology. Therefore, we conducted an analysis of the current scientific literature to provide up-to-date information on the pathogenesis, diagnosis, and management strategies of frozen pelvis. Additionally, we present two case studies from our own practice to illustrate the surgical treatment options for patients with a frozen pelvis.

Conclusion: Our analysis of the literature and clinical observations highlights the complexity of diagnosing and surgically treating frozen pelvis in gynecological practice. An interdisciplinary approach, individualized treatment strategies, preventive measures, and long-term monitoring are crucial for optimizing treatment outcomes and improving patient quality of life. Gynecologists who encounter this challenging condition should continually expand their knowledge and skills, exchange experience, and collaborate with other specialists to enhance diagnostics and patient management.

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About the authors

Vitaly B. Tskhay

V.F. Voino-Yasenetsky Krasnoyarsk State Medical University; Federal Siberian Research Clinical Center under FMBA of Russia

Author for correspondence.
Email: tchai@yandex.ru

Dr. Med. Sci., Professor, Head of the Department of Perinatology; Scientific Director for Obstetrics and Gynecology

Russian Federation, Krasnoyarsk; Krasnoyarsk

Aleksey M. Polstyanoy

Federal Siberian Research Clinical Center under FMBA of Russia

Email: al-polstyanoy@yandex.ru

PhD (Med.), Head of the Gynecological Department

Russian Federation, Krasnoyarsk

Alexander M. Iptishev

V.F. Voino-Yasenetsky Krasnoyarsk State Medical University

Email: alexandriptishev@gmail.com

Resident of the Department of Perinatology

Russian Federation, Krasnoyarsk

Alexander Khudyakov

Private clinic «GTK-Krefeld»

Email: khudyakov@gtk-krefeld.de

Obstetrician-Gynecologist

Germany, Krefeld

Michael Friedrich

Helios Klinikum fur Frauenheilkunde und Geburtshilfe

Email: michael.friedrich@helios-kliniken.de

Dr. Med. Sci., Professor, Chief Physician of the Perinatal Center, Gynecological Oncological Center, Center of Operative Gynecology

Germany, Krefeld

Michael von Westernhagen

Private clinic «GTK-Krefeld»

Email: westernhagen@gtk-krefeld.de

Obstetrician-Gynecologist

Germany, Krefeld

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2. Fig. 1. A - echogram in the frontal plane, on the left - the body of the uterus, on the right - the isthmus of the uterus, behind them an endometrioid infiltrate measuring 32.2 x 20.6 mm; B - echogram in the sagittal plane, an infiltrate measuring 24.3 x 23.7 mm is determined retrocervically

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3. Fig. 2. Intraoperatively: A, B - extensive adhesions of the pelvic organs, typical for frozen pelvis; Douglas' pouch is obliterated; B, G - review of the pelvic organs after excision of adhesions, mobilization of the rectosigmoid colon and ureters; after resection of the retrocervical endometrioid infiltrate

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4. Fig. 3. Intraoperatively: A - extended retrocervical endometrioid infiltrate; adhesions are dissected, infiltrate is visualized; intestinal loop with endometrioid lesion is mobilized; B - excision of infiltrate within healthy tissues; C - infiltrate is excised; view behind the uterine space at the end of surgery; D - suturing of the defect on the intestinal wall after removal of the endometrioid node by shaving; application of serous-muscular sutures

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