Design: Surgical video

Setting: Surgery occurred in an academic medical center. The patient was positioned in dorsal lithotomy position. Three 5 mm laparoscopic ports were placed.

Patients or Participants: A 24-year-old G1P1001 female with fibromyalgia and history of one prior C-section presented with left lower quadrant pain. Pelvic exam, ultrasound, MRI, and colonoscopy were unremarkable, and the pain was minimally responsive to abdominal wall trigger point injections.

Interventions: She was offered diagnostic laparoscopy, total laparoscopic hysterectomy, bilateral salpingectomy, and left oophorectomy. The uterus and bilateral adnexa were normal appearing on pelvic cavity survey. However, a defect in the peritoneum with exposed rectus muscle was identified in the exact distribution of the patient’s pain. The defect was closed by separating the surrounding peritoneum from the rectus muscle and closing the defect with V-loc suture in a running fashion.

Measurements and Main Results: Following surgery, the patient reported complete resolution of her pelvic pain.

Conclusion: Peritoneal defects should be considered as a potential cause of chronic abdominal and pelvic pain. Additionally, closure of the peritoneum at the time of C-section and laparotomy should be considered particularly in those patients with a history of a chronic pain condition.