東洋医学雑誌

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1 Vol.67 No , 2016 Keizo TOKUMO Department of Obstetrics and Gynecology, Chugoku Central Hospital of the Mutual aid Association of Public School Teachers, Ohazaueiwanari, Miyuki-cho, Fukuyama, Hiroshima , Japan Pelvic congestion syndrome is a condition in women caused by congestion or varicosity of the intrapelvic vein. We report a case of pelvic congestion syndrome managed with keishibukuryogan. The syndrome was diagnosed based on expansion of the left periuterine and ovarian veins. A 61-year-old female presented to our clinic with left lower abdominal pain. NRS was 9 and Terasawa s oketsu score was 40, indicating marked blood stasis. A CT scan revealed vascular expansion (10 mm) of the left ovarian vein. Transvaginal ultrasonography also revealed vascular expansion (6.0 mm) of the left periuterine vein. Based on these findings, a diagnosis of pelvic congestion syndrome was established. She was treated with keishibukuryogan (7.5 g/day). NRS was improved to 1 and Terasawa s oketsu score was improved to 20. The symptoms were resolved within 6 months, and the medication was discontinued. Three months after discontinuation, she presented to our clinic again with left lower abdominal pain. The medication was resumed and the symptom was improved. After 5 months, a contrast enhanced CT scan showed no change of vascular expansion of the left ovarian vein (from 10 to 9 mm). Keishibukuryogan treatment has now been continued for 10 months. pelvic congestion syndrome, keishibukuryogan, oketsu

2 Vol.67 No.3, 2016 mm CT X NRS cm kg BMI S CRPmg dl D IgG IgA

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6 Vol.67 No.3, 2016 CT mm mm CT CT COI Liddle AD, Davies AH. Pelvic congestion syndrome : chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology Taylor Jr HC. Vascular congestion and hyperemia : their effect on structure and function in the female reproductive system. Am J Obstet Gynaecol Beard RW, Highman JH, Pearce S, et al. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet Ahlberg NE,Bartley O, Chidekel N. Circumference of the left gonadal vein. an anatomical and statistical study. Acta Radiol Vascular Lab Giacchetto C, Cotroneo G.B, Marincolo F, et al. Ovarian varicocele : ultrasonic and phlebographic evaluation. J Clin Ultrasound Park SJ, Lim JW, Ko YT, et al. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. Am J Roentgenol Rozenblit AM, Ricci ZJ, Tuvia J, et al. Incompetent and dilated ovarian veins : a common CT finding in asymptomatic parous women. Am J Roentgenol Capasso P, Simons C, Trotteur G, et al. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol Maleux G, Stockx L, Wilms G,et al. Ovarian vein embolization for the treatment of pelvic congestion syndrome : long-term technical and clinical results. JVIR Jpn Pharmacol Ther Itoh T, Terasawa K, Kohta K, et al. Effects of keishibukuryo-gan and Trapidil on the microcirculation in patients with cerebro-spinal vascular disease.

8 The Bulletin of Meiji University of Integrative Medicine API II 61 ASO X 11 7 X-4 6 X m 5 X-2 4 X 3 9 X 11 7 API 0.84 ASO X 1 1 MR-angio

8 The Bulletin of Meiji University of Integrative Medicine API II 61 ASO X 11 7 X-4 6 X m 5 X-2 4 X 3 9 X 11 7 API 0.84 ASO X 1 1 MR-angio 7-14 2010 1 1 1 2 1 1 1 2 Fontaine II ASO61 3 API ASO ASO ASO API API KKKKKKKKKK ASO Fontaine II API Received April 14, 2009; Accepted July 16, 2009 I arteriosclerosis obliterans: ASO ASO 50 70 1,2 Fontaine