The cause of her abdominal pain could not be found for years… ‘Varicose veins’ were found in her ovaries Funda Sahillioğlu experienced severe abdominal pain and bloating for 7 years. Sahillioğlu, who received treatment for years for an ovarian cyst, revealed her real illness 3 months ago. She regained her health with a 4-hour operation. The disease, which is seen in women between the ages of 20-50, is defined by experts as a ‘hidden illness’. Sahillioğlu went to a gynecologist 7 years ago due to severe pain in her lower abdomen. The doctor said she might have an ovarian cyst and applied treatment. Her pain did not respond to treatment. The patient was diagnosed with uterine and ovarian varicose veins (pelvic venous congestion syndrome) at a hospital she went to again 3 months ago. The patient was treated at Yeditepe University Koşuyolu Hospital with the Interventional Radiology method by entering a vein in the neck through a needle-hole-sized opening, reaching the varicose ovarian and uterine veins, and blocking the enlarged veins from within the vein (endovascular embolization). Pelvic venous congestion syndrome is usually seen in women between the ages of 20-50. Experts define the disease, which progresses with the enlargement of the veins in the lower abdomen, around the ovaries and uterus, and in the groin, as a hidden disease of women. Sahillioğlu said, “There was such a swelling that it was affecting my waist as well. It was especially swelling more in the summer months. The pain was incredibly affecting my daily comfort. I wanted to finish what I was doing as soon as possible and lie down. I was suffering while doing sports and walking. Now I am not tired, I have no pain.” Yeditepe University Hospital Interventional Radiology Specialist Assoc. Prof. Dr. Melih Topcuoğlu provided information about the treatment and said, “The patient came to us with complaints of swelling and groin pain. The treatments she had previously received did not relieve her illness. Since uterine and ovarian varicose veins are rare, they do not come to mind, and since the correct diagnosis was not made, there was no response to the treatment. If pelvic venous congestion syndrome is not treated, people's quality of life and comfort will seriously deteriorate. There is widespread pain during the day and this pain can wake the patient up at night. The important thing here is to bring the disease to mind and make the correct diagnosis,” he said. Yeditepe University Koşuyolu Hospital Assoc. Prof. Dr. Melih Topcuoğlu, who stated that the blood accumulating there with the apparent enlargement of the veins than normal causes pain, restlessness and bloating, said, “Because, like all veins in the body, the veins in the uterus and ovaries also carry blood towards the heart. When they cannot carry it, the blood starts to pool below. The pooling causes pain, as in our patient. If gynecologists do not think of this disease, many patients lose the chance of being treated.” Interventional Radiology Specialist Assoc. Prof. Dr. Melih Topcuoğlu said, “We use either the main vein in the right groin or the neck to reach the uterine and ovarian veins. We proceed inside the vein by seeing with ultrasound and fluoroscopy (x-ray) guidance. After entering the vein we want to block, we block the entire vein starting from the tip without interruption. We use coils or liquid occlusive agents. After placing these in the vein, the blood clots. As soon as we block the veins, the patient sees the effect of the treatment while on the table and their pain stops. The patient is discharged and goes home within the day.” Giving clues about the disease, Assoc. Prof. Dr. Topcuoğlu said, “If the disease is not too advanced, the procedure is over in 1-1.5 hours. Uterine and ovarian varicose veins are seen in 5 percent of women who apply to gynecologists with complaints of severe lower abdominal pain. Long-lasting lower abdominal and groin pain or pain after sexual intercourse are clues to this disease.” Stating that this disease is generally seen in women who have given birth multiple times, Yeditepe University Hospital Interventional Radiology Specialist Assoc. Dr. Melih Topcuoğlu said, “But it can also be seen structurally in women who have never given birth. It is a condition related to the patient’s blood flow. Women who experience severe menstrual pain should also suspect uterine and ovarian varicose veins and see a doctor if their pain does not go away despite the necessary gynecological treatments.” Yeditepe University Hospital Interventional Radiology Specialist Assoc. Prof. Dr. Melih Topcuoğlu, who stated that ovarian and uterine varicose veins seen in men are called ‘varicocele’, said, “Apart from the ligation method used by urologists, the veins that cause varicocele can be blocked with intravenous treatment methods.”