Frozen Pelvis: How to Proceed?

Abstract

There are many causes of frozen pelvis—endometriosis, PID, adhesions following surgery, etc. The challenges during operating in a case of frozen pelvis are

• Presence of thick dense adhesions completely distorting the anatomy and difficulty in identifying structures.

• Bleeding during every step of dissection which leads to further obscuring of the operating field and increased chances of injuries. The need for blood transfusions and the incidence of anemia due to blood loss are increased.

• Bowel loops can be rigid, less mobile, and more prone to injury.

• Posterior peritoneum can be plastered to the underlying structures making tracing of the ureter difficult.

So, should there be torrential bleeding, it can be very difficult to gain access to internal iliac artery for ligation, and should there be an injury, repair of the injured organ is not easy. The rules for dissection are the same as in any complicated case—sharp dissection, judicious use of cautery, confirm the location of the ureter early in the course of the surgery, not to clamp or cut anything before correctly identifying what is being clamped or cut, not to force open any space, to extend the incision length to facilitate better exposure, calling for more assistants and instruments if necessary, and finally, to check for operative injuries before closing.