1
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Jang S, Jeon M, Mun SJ, Kim SH. Clinical characteristics and risk factors for septic shock in patients with pyometra: A retrospective multicenter cohort study. J Infect Public Health 2024; 17:862-867. [PMID: 38554592 DOI: 10.1016/j.jiph.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Pyometra is a disease characterized by the collection of pus in the uterus. The clinical characteristics and etiology of pyometra have not been sufficiently described. In this study, we investigated the clinical characteristics, epidemiology, outcomes, and risk factors of septic shock in patients with pyometra. METHODS Patients with pyometra admitted to one of four university-affiliated hospitals between January 2010 to August 2022 were enrolled. Pyometra cases associated with peripartum infection and surgical site infection were excluded. Clinical characteristics and outcomes of pyometra were described, and pyometra patients with or without septic shock were compared. RESULTS A total of 192 patients was included. Twenty-eight-day all-cause mortality was 5.0%, and the 1-year recurrence rate was 6.3%. Median patient age was 77.5 years. The two most common symptoms were abdominal pain (49.0%) and vaginal discharge (47.9%). Escherichia coli (40.1%), Klebsiella pneumoniae (16.7%), and Streptococcus spp.(16.0%) were the pathogens most frequently isolated by conventional culture; those isolated from polymerase chain reaction were Mycoplasma hominis (48.0%), and Ureaplasma spp. (32.0%). In multivariable analysis, fever, uterine perforation, and dementia were associated with increased incidence of septic shock, while vaginal discharge was associated with a lower incidence of septic shock. CONCLUSIONS Our findings suggest that pyometra is a unique gynecological infectious syndrome in post-menopausal individuals. The most common associated pathogens are similar to those involved in urinary tract infections rather than those of sexually transmitted diseases. Decreased cognitive function could delay early diagnosis of pyometra and lead to septic shock and higher mortality.
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Affiliation(s)
- Sukbin Jang
- Division of Infectious Diseases, Department of Medicine, Dankook University School of Medicine, Cheonan, Republic of Korea
| | - Minji Jeon
- Division of Infectious Diseases, Department of Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Seok Jun Mun
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
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2
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Reddy LS, Agrawal M, Jaiswal A, Chaudhari K, Dave A. Pyometra Puzzler: Unraveling Senile Endometritis in an Unconventional Presentation. Cureus 2024; 16:e61394. [PMID: 38947584 PMCID: PMC11214656 DOI: 10.7759/cureus.61394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Pyometra is a very uncommon condition in postmenopausal women that rarely improves with standard antibiotic treatments. It is usually overlooked as the patient presents with vague symptoms. Our case presented a postmenopausal woman with sepsis due to a huge pyometra. Swabs for sensitivity, tubercular gene testing, and basic blood workup were done, and the patient was started on intravenous antibiotic therapy. Pyometra drainage could not be done due to thin, friable uterine walls. When the patient had improved, a clinically total abdominal hysterectomy was done after ruling out malignant causes. Delay in the diagnosis of this condition may lead to perforation, which may, in turn, cause peritonitis, which may gravely affect the patient.
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Affiliation(s)
- Lucky Srivani Reddy
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manjusha Agrawal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Apoorva Dave
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Krishna N, Aggarwal K, Lal P, Singh A. Postmenopausal Idiopathic Spontaneous Rupture of Pyometra with Tubo-ovarian Abscess: An Atypical Presentation. J Midlife Health 2024; 15:112-114. [PMID: 39145259 PMCID: PMC11321515 DOI: 10.4103/jmh.jmh_6_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 08/16/2024] Open
Abstract
Spontaneous perforations in pyometra occur rarely. Incidence is only 0.01%-0.5% in gynecological patients. Tubo-ovarian abscess (TOA) is seen less in postmenopausal women amounting the 6%-18% of the total cases of TOA reported. A 52-year-old P3L3 postmenopausal woman with abdominal pain was admitted to hospital. Emergency laparotomy was performed in view of pyoperitoneum. Intraoperatively, 1000 cc of foul-smelling pus was suctioned out from the peritoneal cavity a 2 cm × 2 cm sized perforation was seen at the right fundal region of the uterus and a right sided TOA was seen extending to the uterine cavity, left sided ovary was normal. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The patient got discharged on the 36th postoperative hospitalization day. Histopathological study revealed uterine purulent inflammation with no evidence of malignancy. The diagnosis of spontaneous perforation of pyometra is rarely made preoperatively and the possibility of a perforated pyometra should, therefore, be considered when elderly women suffer from acute abdominal pain. Hysterectomy and bilateral salpingo-oophorectomy may be the best choice procedure in these patients. There is probably a new trend in the epidemiology of TOA, occurring in older women who do not present the traditional risk factors for pelvic inflammatory disease and TOA.
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Affiliation(s)
- Nikita Krishna
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Kiran Aggarwal
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Prabha Lal
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Anuradha Singh
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
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4
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Gupta S, Ambatkar V, Kotdawala K. A Rare Case of Recurrent Hematometra of Unknown Etiology. Cureus 2022; 14:e29217. [PMID: 36258931 PMCID: PMC9569415 DOI: 10.7759/cureus.29217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 12/04/2022] Open
Abstract
An abnormal blood collection in the uterus is referred to as hematometra. Obstruction of the genitourinary outflow system caused by earlier surgeries or congenital defects is most frequently related to this rare disorder. The symptoms of hematometra include acute pelvic pain and a history of absent menarche. Here is a case of a 42-year-old female who presented with complaints of severe lower abdominal pain, and pain during urination that was accompanied by vulval itching in June 2021. She had undergone two Caesarean sections and a myomectomy in the past. She was given three monthly injections of gonadotropin-releasing hormone (GnRH) analogue after receiving USG-guided drainage because of a diagnosis of hematometra in January 2021. However, in June 2021, she experienced a recurrence of the same symptoms, necessitating a total abdominal hysterectomy and bilateral salpingo-oophorectomy, which completely resolved the patient's complaints. For a deeper understanding of this issue, further case reporting is necessary.
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5
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Okusaki T, Araki Y, Narai S, Hamada T, Kusunoki R, Oda A, Nakamura H. Pyometra and Pyogenic Spondylitis with Suspected Involvement of Diverticulitis of the Sigmoid Colon: A Case Report. Intern Med 2022; 62:1231-1235. [PMID: 36104192 PMCID: PMC10183279 DOI: 10.2169/internalmedicine.0064-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pyometra is a rare disease in which pus accumulates in the uterus and is typically caused by stenosis of the cervix. Only a few case reports have indicated that diverticular disease causes pyometra. We herein report an 83-year-old woman presented to our hospital with a fever, loss of appetite, general fatigue and back pain. After some inspections, she was diagnosed with pyometra and lumbar pyogenic spondylitis secondary to diverticulitis of the sigmoid colon. We performed transvaginal drainage and continued antibiotic administration for about three months. The pyometra and pyogenic spondylitis successfully resolved, and she did not experience any recurrence.
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Affiliation(s)
- Tai Okusaki
- Department of Respiratory Medicine, Kure Medical Center, Japan
| | - Yusuke Araki
- Department of Respiratory Medicine, Kure Medical Center, Japan
| | - Seika Narai
- Department of Respiratory Medicine, Kure Medical Center, Japan
| | - Takuro Hamada
- Department of Gastroenterology, Kure Medical Center, Japan
| | | | - Akihiro Oda
- Department of Orthopaedic surgery, Kure Medical Center, Japan
| | - Hiroko Nakamura
- Department of Obstetrics and Gynecology, Kure Medical Center, Japan
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6
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Shu XY, Dai Z, Zhang S, Yang HX, Bi H. Endometrial squamous cell carcinoma originating from the cervix: A case report. World J Clin Cases 2022; 10:8782-8787. [PMID: 36157822 PMCID: PMC9453359 DOI: 10.12998/wjcc.v10.i24.8782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/12/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical squamous cell carcinoma (SCC) is the most common type of cervical carcinoma and is generally derived from a precancerous stage called cervical high-grade squamous intraepithelial lesion (HSIL). Usually, the cancer metastasizes through lymphatic or hematogenous dissemination, but rarely spreads upward into the uterus. Here, we report a case of cervical HSIL extending into the endometrium and finally progressing to SCC in the uterine cavity.
CASE SUMMARY A 57-year-old postmenopausal woman visited our department and requested a routine cervical check-up. Four years ago, she had undergone a cervical loop electrosurgical excision procedure because of HSIL found during the gynecological examination, and she had not been checked again since. This time, a relapse of the cervical HSIL was diagnosed along with uterine pyometra and endometrial polyps. After 2 wk of antibiotic treatment, a laparoscopic hysterectomy was performed, and the final pathological examination revealed that the cervical HSIL had spread directly upward into the uterine cavity, gradually developing into cervical SCC in the endometrium.
CONCLUSION Cervical HSIL/SCC can directly spread upward into the uterus with the most common symptoms of pyometra and cervical stenosis. More attention should be given to the early detection and prevention of this disease.
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Affiliation(s)
- Xin-Yu Shu
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
| | - Zhang Dai
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
| | - Shuang Zhang
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Hui-Xia Yang
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
| | - Hui Bi
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
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7
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Matsumoto R, Kuramoto S, Muronoi T, Oka K, Shimojyo Y, Kidani A, Hira E, Watanabe H. Damage control surgery for spontaneous perforation of pyometra with septic shock: a case report. Acute Med Surg 2021; 8:e657. [PMID: 34026231 PMCID: PMC8133080 DOI: 10.1002/ams2.657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background Although spontaneous perforation of pyometra is very rare, it sometimes causes severe peritonitis, leading to lethal conditions. Damage control surgery reportedly improves the survival of critically ill patients; however, there has been no report describing damage control surgery for ruptured pyometra. Case presentation An 83‐year‐old postmenopausal woman with generalized peritonitis and septic shock was admitted and underwent emergency laparotomy. Abbreviated surgery was carried out because of progressing septic shock, and planned reoperation was carried out 2 days after the initial surgery. Histopathological examination revealed the perforation of pyometra with no evidence of malignancy. The patient was discharged on the 32nd postoperative day in stable condition. Conclusion We report a case of spontaneous perforation of pyometra with severe septic shock successfully treated by damage control surgery. Damage control surgery is a useful treatment option for hemodynamically unstable patients with diseases in the field of obstetrics and gynecology.
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Affiliation(s)
- Ryo Matsumoto
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Shunsuke Kuramoto
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Tomohiro Muronoi
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Kazuyuki Oka
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Yoshihide Shimojyo
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Akihiko Kidani
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Eiji Hira
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Hiroaki Watanabe
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
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8
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Damage Control Management of Perforating Pyometra Presenting with Septic Shock after the Return of Spontaneous Circulation. Case Rep Med 2020; 2020:8545232. [PMID: 33273927 PMCID: PMC7695505 DOI: 10.1155/2020/8545232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/18/2020] [Accepted: 11/09/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Perforation of pyometra is often severe but rare. We report a case of pyometra detected on second-look surgery in an elderly patient with life-threatening septic shock and cardiopulmonary arrest before hospital arrival. Case Presentation. A 70-year-old woman with cardiopulmonary arrest received adrenaline. Computed tomography revealed ascites, and abdominal paracentesis was performed to identify the cause of cardiopulmonary arrest. The ascitic fluid was purulent, and intraperitoneal infection was identified. Emergency exploratory laparotomy revealed pyometra. Conclusion If perforated, pyometra may cause peritonitis and lethal septic shock. Not only gynecologists but also emergency physicians should be aware of this possibility. Moreover, patient education is necessary. In patients with cardiopulmonary arrest, diagnostic abdominal paracentesis should be performed when the sole imaging finding is ascites. Improving outcomes in patients with difficult-to-diagnose pyometra with cardiopulmonary arrest by implementing damage control strategies before hysterectomy is possible.
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9
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Singh P, Malhotra V, Nanda S, Chauhan MB. Spontaneous Perforation of Pyometra: A Case Series and Review of the Literature. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Parul Singh
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vani Malhotra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Smiti Nanda
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Meenakshi Barsaul Chauhan
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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10
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Yazawa H, Imaizumi K. Generalized peritonitis secondary to spontaneously perforated pyometra in elderly women:two cases with different clinical courses and surgical approaches and review of the literature. Fukushima J Med Sci 2020; 66:53-59. [PMID: 32281585 PMCID: PMC7269882 DOI: 10.5387/fms.2019-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe two cases of spontaneously perforated pyometra (SPP) in elderly women treated with two different surgical approaches. An 88-year-old woman underwent emergency laparotomy for presumed diagnosis of gastrointestinal (GI) tract perforation. During surgery, SPP and a tumor of the sigmoid colon were identified. Total hysterectomy and sigmoid colon resection were performed. Despite exhaustive postoperative treatments, the patient died on postoperative day (POD) 189 due to peritonitis and pneumonia. A 93-year-old woman with acute abdomen was diagnosed with severe pyometra and primarily treated with transcervical drainage. Due to progression of generalized peritonitis, laparoscopic surgery was performed. Intraoperatively, scar from a uterine body perforation was identified, leading to the diagnosis of SPP. Only peritoneal irrigation and drainage were performed, in consideration of her advanced age. She improved and was discharged from the hospital on POD 35. The prognosis for SPP is sometimes poor, especially in older women. Minimally invasive surgical intervention might be considered for primary treatment in such cases.
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Affiliation(s)
- Hiroyuki Yazawa
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital
| | - Karin Imaizumi
- Department of Obstetrics and Gynecology, Iwase General Hospital
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11
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Urushidani S, Kuriyama A. Large Pyometra Mimicking the Bladder in an Elderly Female Patient. J Emerg Med 2020; 58:e161-e163. [PMID: 31982200 DOI: 10.1016/j.jemermed.2019.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/25/2019] [Accepted: 11/23/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Seigo Urushidani
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
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12
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Tay WMI, Subramanian M, Chinchure D, Kok SXS. Clinics in diagnostic imaging (199). Pyometra. Singapore Med J 2019; 60:487-490. [PMID: 31570949 DOI: 10.11622/smedj.2019113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 92-year-old woman presented to the emergency department with urinary symptoms, fever and suprapubic tenderness. Her inflammatory markers were raised. Urine and blood cultures were negative. Computed tomography performed to look for a source of sepsis showed distension of the uterine cavity with high-attenuation fluid, an air-fluid level and gas locules along the uterine wall. The causes, clinical presentation and imaging features of pyometra are discussed.
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Affiliation(s)
- Wei Ming Ian Tay
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Dinesh Chinchure
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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13
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McLeod N, Lastinger A. Pyometra due to Pseudomonas aeruginosa. IDCases 2019; 17:e00554. [PMID: 31193089 PMCID: PMC6517525 DOI: 10.1016/j.idcr.2019.e00554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/15/2022] Open
Abstract
Pyometra is an unusual presentation of uterine infection, this condition is characterized by purulent fluid within the uterine cavity. In this report we describe pyometra due to Pseudomonas aeruginosa in a 90-year-old woman who presented with abdominal pain, nausea with emesis and diarrhea. She was evaluated at an outside emergency department and computed tomography (CT) revealed a large, complex, cystic mass measuring 9.2 cm (cm) in greatest diameter. Given her age, the diagnosis of malignancy was entertained. She was referred to gynecologic-oncology service for evaluation and underwent exploratory laparotomy with total abdominal hysterectomy and lysis of adhesions. Intraoperative findings were consistent with pyometra. Cultures ultimately grew Pseudomonas aeruginosa. She initiated on antibacterial therapy and was discharged to a rehabilitation facility.
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Affiliation(s)
- Nathan McLeod
- Department of Medicine, Section of Infectious Diseases, PO Box 9163, West Virginia University School of Medicine, Morgantown, WV, 26506-9214, United States
| | - Allison Lastinger
- Department of Medicine, Section of Infectious Diseases, PO Box 9163, West Virginia University School of Medicine, Morgantown, WV, 26506-9214, United States
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14
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Balas Ş, Yılmaz KB, Yıldırım SA, Açıkgöz B, Tatar İG, Bayar B, Akıncı M, Kaya O. Spontaneous perforation of pyometra: A rare cause of acute abdomen and sepsis. Turk J Surg 2018; 34:342-345. [PMID: 30664439 DOI: 10.5152/turkjsurg.2017.3203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022]
Abstract
Pyometra, the accumulation of purulent material in the uterine cavity, is a rare gynecological condition whose etiology is impaired drainage of the uterine cavity. It is uncommon in premenopausal age and occurs mainly in older and postmenopausal women. Clinical signs of pyometra are vaginal discharge, postmenopausal bleeding, and lower abdominal pain. An 87-year-old woman was admitted to our emergency department with abdominal pain, fever, and vomiting. The results of physical examination revealed rebound tenderness and muscular rigidity in the lower abdomen. Ultrasonography demonstrated free fluid in the abdomen, and percutaneous aspiration revealed that this fluid was purulent. A computed tomography scan showed a large amount of free fluid in the abdominal cavity and a uterine myoma. The patient underwent emergency laparotomy due to acute abdomen. During the laparotomy, a 2×1 cm perforation was seen at the fundus of the uterus. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. A culture of the pus grew Escherichia coli. Histopathological examination revealed degenerative uterine myoma with no evidence of malignancy. Pathological results indicated myometrial suppurative inflammation along with neutrophilia and necrosis. Pyometra is a rare event; however, it must be considered when investigating acute abdomen etiology. Because pyometra involves abscess formation, drainage and evacuation of the uterine cavity while leaving a drain in the cavity and dilating the cervical canal is the main treatment protocol. In cases of perforation, hysterectomy is the treatment choice; however, with concomitant diseases in older patients, immediate surgery is related to important morbidity and mortality risks.
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Affiliation(s)
- Şener Balas
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Kerim Bora Yılmaz
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Seray Akçalar Yıldırım
- Clinic of Radiology, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Bilgihan Açıkgöz
- Clinic of Pathology, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - İdil Güneş Tatar
- Clinic of Radiology, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Bahattin Bayar
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Melih Akıncı
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Oskay Kaya
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
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15
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Su HY, Hung YH, Li HM, Hsu CW. Elderly Woman With Diffuse Abdominal Pain. Ann Emerg Med 2017; 69:793-801. [PMID: 28545700 DOI: 10.1016/j.annemergmed.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Hung-Yuan Su
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Koahsiung, Taiwan
| | - Yun-Hsiang Hung
- Department of Department of Obstetrics and Gynecology, E-Da Hospital and I-Shou University, Koahsiung, Taiwan
| | - Hao-Ming Li
- Department of Radiology, E-Da Hospital and I-Shou University, Koahsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Koahsiung, Taiwan
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