Minimally invasive management of pyoperitoneum attributed by spontaneous perforated pyosalpinx and pyometra

Pyoperitoneum, apart from bowel perforation, can occur due to gynecologic causes like ruptured pyometra or ruptured tubo-ovarian abscess. Earlier, the management of pyoperitoneum included broad-spectrum antibiotics and emergency laparotomy with or without a hysterectomy and bilateral saphingo-oophorectomy. A higher rate of surgical complications like bowel or bladder injury was noted with surgery, and future fertility was also compromised in these patients. Later on, treatment strategies improved to laparoscopic drainage of pus with antibiotics without extensive surgery. However, such cases can be managed with an even more minimally invasive approach by image-guided pigtail drainage. In this report, we describe two cases of pyoperitoneum that were managed successfully with pigtail insertion and continuous drainage of pus along with antibiotics obviating the need for anaesthesia and surgery. It seems to be a promising approach for pyoperitoneum in a hemodynamically stable patient, not showing any features of severe sepsis.

Postpartum pyomyoma: two cases report and literature review / 中华围产医学杂志

Objective:To investigate the clinical characteristics of postpartum pyomyoma.Methods:Clinical data of two patients with postpartum pyomyoma admitted to the Department of Obstetrics and Gynecology, Peking University First Hospital, between 2019 and 2020, were collected. Another 16 postpartum pyomyoma reported in China and foreign areas from 2000 to 2020 were reviewed.Results:Apart from three patients without reported gravidity and parity, 12 out of the remaining 15 patients were primiparous. The median maximum diameter of uterine fibroids in pregnancy was 10 cm (6-25 cm). Of the 18 patients, 12 had a history of intrauterine manipulation, 10 had anemia or severe postpartum hemorrhage, and four had other infections. All patients manifested as fever at first, and most were accompanied by abdominal pain. The onset time of 14 cases was within postpartum two weeks. CT, MRI, and ultrasound detection rate in diagnosing postpartum pyomyoma was 11/13, 3/6, and 1/8, respectively. Pus culture had the highest positive rate, with Escherichia coli as the most common pathogen. No death was reported, but 14 patients developed severe complications, including sepsis, septic shock, disseminated intravascular coagulation, rupture of pyomyoma, peritonitis, and incision infection. As failing in anti-infection medication, all patients received surgical treatment, which controlled infections. Three patients were conceived two years after the operation (16 months to two years). Conclusions:Pyomyoma should be considered once postpartum fever develops in patients complicated by uterine fibroids ≥10 cm in diameter during pregnancy, especially those with anemia, infection, or a history of intrauterine manipulation. Surgical treatment should be performed once pyomyoma is diagnosed.

Studies on Haemto-biochemical and Physiological Parameters in Canine Pyometra

Canine pyometra is an acute or chronic polysystemic diestrual disorder mainly of mature nulliparous bitches. In this retrospective study, an attempt was made to analyse the physiological and haemato-biochemical parameters of a total of 22 affected bitches attended at Sneh Vet lab and Clinic Bhadra, Bhiwani, (Haryana). The findings revealed pyrexia and tachycardia with normal respiration rate in most of the pyometra affected bitches. Amongst the haemato-biochemical parameters, there were reduced levels of haemoglobin, packed cell volume and total erythrocyte count, along with severe leucocytosis, neutrophilia with shift to left, lymphopenia, eosinophilia and elevated BUN and serum creatinine in the bitches affected with pyometra suggesting bone marrow and renal damage. However, the mean values of mean corpuscular volume, mean corpuscular haemoglobin as well as serum ALT and AST were within the normal range, confirming normocytic normochromic anaemia without liver dysfunction.

A Study on Different Diagnostic Approach for Early Recognition of Canine Pyometra

The study aimed to evaluate ultrasonographic findings, radiography, and blood profile in 24 bitches presented for treatment of pyometra. Clinical symptoms such as anorexia, vaginal discharge, depression, polyuria/polydipsia, vomiting, and abdominal distension were seen. Among these various types of diagnostic approaches, ultrasonography a powerful tool for the early detection of uterine abnormalities. Before any clinical alterations could be noticed, ultrasonography allowed the diagnosis of pathologic abnormalities. Pyometra must be identified, diagnosed, and treated as soon as possible to achieve a successful outcome

Piometra secundario a estenosis cervical en una adolescente / Pyometra secondary to cervical stenosis in an adolescent

INTRODUCCIÓN: El piometra es una afección infrecuente, pero grave, que en general se diagnostica en mujeres posmenopáusicas. En adolescentes es sumamente raro, y si se acompaña de amenorrea primaria hay que tener en mente las anomalías congénitas. CASO CLÍNICO: Adolescente de 13 años, sin antecedentes personales de interés salvo amenorrea primaria, que acude con abdomen agudo y es intervenida por una peritonitis difusa causada por un piometra secundario a disgenesia (estenosis) cervical congénita. Se realizó dilatación cervical y se dejó una sonda vesical intrauterina para prevenir la reestenosis. CONCLUSIONES: Un diagnóstico precoz y un tratamiento conservador con dilatación cervical y colocación temporal de un catéter urinario son esenciales para un manejo seguro y efectivo de la estenosis cervical en adolescentes.

INTRODUCTION: Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. In adolescents it is extremely rare; if accompanied by primary amenorrhea, consider congenital abnormalities. CASE REPORT: A 13-year-old adolescent, with no relevant personal history except primary amenorrhea, who presented with an acute abdomen and was operated on for diffuse peritonitis caused by pyometra secondary to congenital cervical dysgenesis (stenosis). Cervical dilation was performed and a urinary catheter was temporarily placed inside the uterus to prevent restenosis. CONLUSIONS: An early diagnosis and conservative treatment with cervical dilation and temporary placement of a urinary catheter are essential for the safe and effective management of cervical stenosis in adolescents.

Tubercular pyometra in a young unmarried female - dilemma and pitfalls in diagnosis: a rare case report with review of literature

This rare case is the first case being reported as tubercular pyometra in a young unmarried woman. Diagnosis of genital tuberculosis which is a form of EPTB (extra pulmonary TB) can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens. A negative smear for acid-fast bacilli, lack of granuloma on histopathology and failure to culture mycobacterium tuberculosis do not exclude the diagnosis of EPTB. A 25-year-old unmarried, government employee from Bihar presented to our OPD with secondary amenorrhea for two months carrying with her an USG, CT and MRI done in Bihar suggesting enlarged uterus with fluid collection. CT-also reported few enlarged lymph nodes. Her preoperative investigations revealed an elevated ESR and x-ray chest was normal. Dilatation was done under ultrasonic guidance in OT and 150 cc of thick caseous material was drained A gentle curettage was done on lateral wall near cornea and both the caseous material and endometrial tissue was sent for gram staining, TB-PCR (polymerase chain reaction), NAAT (nucleic acid amplification techniques) and culture. In the post-operative period gram staining for AFB, NAAT, TB-PCR all came negative and it was difficult to convince patient to take ATT. However, on day 10, HPE report came as granuloma suggestive of TB and patient was put on ATT. Culture too was reported negative later.  Paucibacillary female genital TB (FGTB) is difficult to diagnose because of varied presentation and limitations of diagnostic tests A raised ESR is presumptive but non-specific. Other tests are x-ray chest, HSG, endometrial tissue for TB PCR nucleic acid amplification techniques (NAAT, HPE and culture (conventional or Bactec). Patients with EPTB are, however, more likely to have negative sputum smear results and many EPTB cases do not have direct lung involvement.  Currently, there are no standard guidelines or algorithm for the diagnosis of FGTB. Female genital TB has varying presentation and diagnosis is difficult because of the paucibacillary nature.

Vaginal stenosis with cervical intraepithelial neoplasia in a postmenopausal patient with pyometra: a diagnostic dilemma

Postmenopausal patient presenting with pain and lump in abdomen should be considered as a complication caused by gynaecological malignancy unless proved otherwise pyometra is most common in postmenopausal women but it can affect women of child bearing age as well. Usually it is caused by impairment of natural drainage of the cervix due to malignant diseases of genital tract and consequences of their treatment with radiotherapy. Authors report one such case with cervical intraepithelial neoplasia with uterus markedly enlarged to 26-28 weeks size with Vaginal stenosis in an eighty-year-old postmenopausal patient.

Pyometra in the postpartum: a forgotten complication

We report a case of 37 years old women who conceived after in vitro fertilization (IVF). Her antenatal course was uneventful. On delivery there was placenta acreta. She later presented in the postpartum period with pyometra. She was managed with conservative treatment. We believe that the placental bed sutures and the sloughing placenta could have led to sterile pyometra in this patient. This rare but important complication need to be kept in mind specially in high risk women with thin endometrium, h/o IVF, cervical encerclage, and placenta acreta.

Protein-to-creatinine urinary in the early diagnosis of renal injury in canine pyometra / Relação proteína-creatinina-urinária no diagnóstico precoce de lesão renal em cadelas com piometra

Kidney disease that affects bitches with pyometra may lead patients to develop chronic renal failure even after pyometra treatment. Therefore, several studies have sought to clarify the gaps in the understanding of the pathogenesis of renal injury in pyometra. Identification of early detection markers for renal damage, which can predict and identify the prognosis of the disease, is very important. Proteinuria analysis can diagnose kidney damage, since proteins such as albumin are not filtered through the glomerulus and those that undergo glomerular filtration are almost completely reabsorbed by tubular cells. The objective of this study was to evaluate whether the urinary protein-to-creatinine ratio (UPC) can detect renal injury in bitches with pyometra before development of azotemia. For this, 44 bitches with pyometra were divided into two groups: bitches with azotemic piometra (A, n=15, creatinine >1.7) and bitches with non-azotemic pyometra (NA, n=29). The two groups were compared to the control group (CG, n=12), which had no signs of systemic disease. All animals underwent blood and urine tests. Leukocytosis was more evident in bitches in the A group than in the other groups. This shows that the inflammatory response may be associated with the pathogenesis of renal injury. The median UPC in bitches with pyometra was significantly higher than in the CG, with a median above the reference values. In conclusion, the UPC can be used in bitches with pyometra to detect renal damage before the development of azotemia. It has been suggested that the UPC of bitches with pyometra should be followed through during the postoperative period so that permanent renal lesions secondary to pyometra can be diagnosed and treated properly before the development of azotemia.(AU)

A doença renal que afeta cadelas com piometra pode levar a insuficiência renal crônica mesmo após o tratamento. Portanto, vários estudos procuraram esclarecer as lacunas na compreensão da patogênese da lesão renal na piometra. A identificação de marcadores de lesão renal precoce, que podem prever e identificar o prognóstico da doença é muito importante. A análise da proteinúria pode diagnosticar lesão renal, uma vez que proteínas como a albumina não são filtradas através do glomérulo e aquelas que sofrem filtração glomerular são quase completamente reabsorvidas pelas células tubulares. O objetivo deste estudo foi avaliar se a relação proteína-creatinina urinária (UPC) pode detectar lesão renal em cadelas com piometra antes do desenvolvimento de azotemia. Para isso, 44 cadelas com piometra foram divididas em dois grupos: cadelas com piometra azotêmica (A, n=15, creatinina >1,7) e cadelas com piometra não azotêmica (NA, n=29). Os dois grupos foram comparados ao grupo controle (CG, n=12), que não apresentaram sinais de doença sistêmica. Todos os animais foram submetidos a exames de sangue e urina. A leucocitose foi mais evidente nas cadelas do grupo A do que nos outros grupos. Isso mostra que a resposta inflamatória pode estar associada à patogênese da lesão renal. A mediana da UPC em cadelas com piometra foi significativamente maior que no CG, com uma mediana acima dos valores de referência. Em conclusão, a UPC pode ser usada em cadelas com piometra para detectar lesões renais antes do desenvolvimento de azotemia. Sugeriu-se que a UPC de cadelas com piometra deve ser acompanhada durante o pós-operatório, de modo que as lesões renais permanentes secundárias à piometra possam ser diagnosticadas e tratadas adequadamente antes do desenvolvimento de azotemia.(AU)

Clinics in diagnostic imaging (199). Pyometra

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.

Fertility outcome after medically treated pyometra in dogs

Cystic endometrial hyperplasia-pyometra complex (CEH/P) is a challenge in canine reproduction. Present study aimed to assess fertility after medical treatment. One-hundred-seventy-four bitches affected by CEH/P received aglepristone on days 1, 2, 8, then every 7 days until blood progesterone < 1.2 ng/mL; cloprostenol was administered on days 3 to 5. Records were grouped according to bodyweight (BW): small (< 10 kg, n = 33), medium (10 ≥ BW < 25 kg, n = 44), large (25 ≥ BW < 40 kg, n = 52), and giant bitches (BW ≥ 40 kg, n = 45). Age; success rate; aglepristone treatments number; relapse, pregnancy rates; diagnosis-relapse,

Carcinoma pavimentoso primario del endometrio: una entidad de muy difícil diagnóstico / Primary endometrial squamous cell carcinoma: an entity of very difficult diagnosis

Se presenta un caso de mujer postmenopáusica, goajira, sin criterios de riesgo para adenocarcinoma del endometrio, que mediante el legrado uterino por aspiración de piometra se diagnosticó un carcinoma pavimentoso primitivo epitelial del endometrio (CPPEE), por llenar algunos criterios: no invasión al cuello, ni extensión de uno cervical al endometrio, ni la presencia de queratinización de la superficie endometrial y/o puentes intercelulares. No hubo evidencia de presencia de virus de papiloma humano (VPH). Después de la histerectomía se encontró que sí existía un tumor endometrial grado III, estadio IB. compuesto por elementos glandulares y tejido escamoso en ciertas áreas. Tampoco existían criterios para un diagnóstico de ictiosis uterina, infiltrante, sin componente velloso, Hubo confusión en el diagnóstico inicial. La rareza del CPPEE, menos de 100 casos reportados en el mundo, condujo al análisis con varios patólogos. Se concluye que para obtener el diagnóstico correcto, deben llenarse los criterios de Flumman y de la Organización Mundial de la Salud, excluir infección del tracto genital por VPH, los estudios de inmunohistoquímica deben ser positivos para queratinas y carecer de receptores para estrógenos y progesterona. El legrado o la biopsia no son confiables para el diagnóstico. Además de la evaluación histológica y del estadio clínico, el estudio de toda la pieza quirúrgica es fundamental para emitir pronóstico(AU)

A goajira menopausal woman, with no risk criteria for endometrial adenocarcinoma, was diagnosed through uterine curettage by aspiration of pyometra as primary squamous carcinoma of the endometrium (CPPEE) to meet following criteria: no invasion of the cervix, no extension of the cervical to the endometrium, absence of keratinization of the endometrial surface and intercellular bridges. There was no evidence of human papillomavirus. After the hysterectomy, there was an endometrial tumor composed of glandular elements and squamous tissue in areas, without filling the elements for diagnosis of ichthyosis uteri, infiltrating, without vellous component, grade III and stage IB. There was confusion in the initial diagnosis. The rarity of the CPPEE, less than 100 cases in the world, led to the analysis with several pathologists. It is concluded that in order to obtain the correct diagnosis, it must meet the criteria of Flumman and WHO, exclude infection of the genital tract by HPV, immunohistochemical studies must be positive for keratins and lack estrogen and progesterone receptors. The curettage or the biopsy are not reliable and the study of the whole surgical part is fundamental. In order to establish a prognosis, an accurate diagnosis must be made(AU)

Herlyn-werner-wünderlich syndrome: case report

ABSTRACT Introduction: The Herlyn-Werner-Wünderlich (HWW) syndrome is the association of three urogenital anatomic alterations of low incidence. Müllerian alterations are rare and are usually incidental findings; consequently, they are underdiagnosed and their genesis and correlation with having a higher probability of expression on the right side are unknown. Case Report: This is the case of a 17-year-old patient who consulted for severe hypogastric abdominal pain linked to foul-smelling bleeding. On physical examination, a vaginal septum was found, while complementary images showed uterus didelphys and renal agenesis, leading to diagnose HWW syndrome. Furthermore, pyometra and hematocolpus were also documented and managed with antibiotic therapy. Given the adequate response to treatment, hospital discharge was authorized with follow-up by external consultation, since the definitive management could not be provided during hospital stay. Discussion: One of the causes of recurrent abortions is the presence of this syndrome; however, when properly diagnosed, definitive treatment can be provided to reduce con-ceptional losses and urogenital hematopuru-lent collections. Conclusions: HWW syndrome is a rare malformation that increases the risk of suffering from gynecological infectious diseases or blood collections. Surgical management of the vaginal septum is a definitive treatment that improves quality of life and reduces the risk of morbidities associated with the pathology.

RESUMEN Introducción. El síndrome de Herlyn-Werner-Wünderlich (HWW) es una asociación de tres alteraciones anatómicas urogenitales de baja incidencia. Las alteraciones müllerianas son poco comunes y suelen ser hallazgos incidentales, por lo que se encuentran subdiag-nosticadas y poco se conoce su génesis o su relación con tener más probabilidad de expresión en el lado derecho. Reporte de caso. Se trata de una paciente de 17 años quien consultó por dolor abdominal hipogástrico de fuerte intensidad ligado a sangrado fétido. En el examen físico se encontró tabique vaginal y en las imágenes complementarias se evidenció útero didelfo y agenesia renal, diagnosticando así síndrome HWW. Igualmente, se documentó piómetra y hematocolpos que se manejaron con terapia de antibióticos; dada la adecuada respuesta al tratamiento, se dio egreso hospitalario con seguimiento por consulta externa, pues el manejo definitivo no se pudo proporcionar durante la estancia hospitalaria. Discusión. Una causa de abortos a repetición es la presencia de síndrome HWW; sin embargo, al ser correctamente diagnosticado, se puede dar un tratamiento definitivo que disminuya las perdidas concepcionales y colecciones hematopurulentas urogenitales. Conclusiones. El síndrome HWW es una malformación poco común que aumenta el riesgo de padecer cuadros infecciosos ginecológicos o colecciones hemáticas. El tratamiento definitivo consiste en el manejo quirúrgico del tabique vaginal que mejora la calidad de vida y disminuye el riesgo de morbilidades asociadas a la patología.

Perforation of pyometra presenting as obstructive acute abdomen and peritonitis: a case report / Perfuração de piometra apresentando-se como abdômen agudo obstrutivo e peritonite: relato de caso

ABSTRACT We report a rare case of a 67-year-old postmenopausal woman presenting diffuse peritonitis secondary to spontaneous perforation of pyometra with obstructive acute abdomen. During laparotomy was performed subtotal abdominal hysterectomy with bilateral salpingo-oophorectomy. The histopathology found the presence of moderately differentiated uterine squamous cell carcinoma. Despite intensive care, the patient died due to multiple organ failure resulting from sepsis on postoperative day 1. This case shows the importance of clinical suspicion on the acute gynecological diseases presenting as a systemic disease in the emergency room.

RESUMO Relatamos um caso raro de uma mulher pós-menopausa com 67 anos de idade, a qual apresentou como peritonite difusa secundária a perfuração espontânea de piometra com abdômen agudo obstrutivo. Durante a laparotomia foi realizada histerectomia abdominal subtotal com salpingo-ooforectomia bilateral. A histopatologia determinou a existência de carcinoma de células escamosas moderadamente diferenciado do útero. Apesar dos cuidados intensivos, a paciente veio a óbito por falência múltipla de órgãos decorrente de sepse no primeiro dia do pós-operatório. Este caso mostra a importância da suspeita clínica sobre as doenças ginecológicas agudas que se apresentam como doenças sistêmicas na sala de emergência.

MRI manifestations of pyometra and comparison with pathologic findings / 实用放射学杂志

Objective To discuss the MRI features of pyometra and its correlation with pathologic.Methods MRI and DWI data of 12 cases pyometra proved by surgery and pathology were analyzed retrospectively, and a comparision with pathologic findings was made.Mean ADC values were calculated.Results According to the homogeneity of MRI signal: Uniform signal type in 2 cases,T1WI showed slightly low signal,T2WI showed slightly high signal,DWI showed high signal,and the distribution of pus compositions is relatively uniform;Signal mixed type in 5 cases, T2 showed at the bottom of the pus or peripheral mixed slightly short signal, DWI showed mixed high signal, there was some sediment in the bottom of the pus;5 cases of liquid layer type, the upper displayed signal of water,and the lower signal was lower than the upper signal on T2WI, of which 3 cases showed uniform signal of the lower, DWI showed a uniform high signal, the distribution of pus compositions is uniform, the other 2 cases showed mixed signal of the lower, which was pyometra with bleeding,DWI showed high signal and low signal mixed together.The average ADC value of the 12 patients were 0.532×10-3 mm2/s.12 cases of uterine volume were increased, including 10 cases of uterine wall thinning, the other 2 cases with inflammatory invasion, the uterine wall thickening.8 cases with cervical cancer.5 cases with pelvic effusion.Conclusion MRI findings of pyometra are characteristic, its MRI manifestations and pathological components are highly correlated,and the ADC value is of great value in the diagnosis of pyometra.

Sterile Pyometra in Two Dogs

Two young dogs were referred to the Veterinary Medical Teaching Hospital of Konkuk University, one for examination of vaginal discharge and the other after being hit by a car. Dog 1 exhibited a high neutrophil count on Gram-stained vaginal smears, marked leukocytosis on a complete blood count, and uterine enlargement on ultrasonography. In dog 2, a markedly enlarged right uterine horn containing echogenic debris was found incidentally on ultrasonography. A tentative diagnosis of pyometra was made in both cases and ovariohysterectomy was performed. Purulent material was collected from each uterine horn and submitted separately for aerobic and anaerobic bacterial culture; all culture results were negative. The white blood cell count revealed normal limits 2 days post operation in dog 1 and 4 days post operation in dog 2. Positive bacterial cultures are usually obtained from dogs with pyometra, and antibiotic selection is based on the results of culture and sensitivity testing in the event of failure of empiric antibiotic therapy. However, in the cases reported here, no bacterial growth was identified from the uterine samples despite the presence of purulent material. A short course of empiric antibiotic therapy was administered. This is the first known report describing sterile pyometra in dogs.

Pyometra and Pregnancy with Herlyn-Werner-Wunderlich Syndrome / Piometria e gravidez com síndrome de Herlyn-Werner-Wunderlich

ABSTRACT We describe a Herlyn-Werner-Wunderlich syndrome (HWWS) patient with previous history of infertility who got pregnant without treatment and presented a pyometra in the contralateral uterus throughout the gestational period, despite multiple antibiotic treatments. Due to the uterus' congenital anomaly and the possibility of ascending infection with subsequent abortion, this pregnancy was classified as high-risk. We believe that the partial horizontal septum in the vagina may have contributed to the closure of the gravid uterus cervix, thus ensuring that the pregnancy came to term, with an uneventful vaginal delivery.

RESUMO Os autores descrevem uma paciente com síndrome de Herlyn-Werner-Wunderlich (SHWW) e história prévia de infertilidade, que engravidou espontaneamente. Durante todo o período gestacional apresentou, apesar da instituição de antibioticoterapia, um piometra localizado ao útero não gravídico. Devido à anomalia congênita uterina e ao risco de infeção ascendente, com possível desfecho obstétrico desfavorável, esta gravidez foi classificada de alto risco. O septo vaginal horizontal e parcial poderá ter contribuído para ausência de disseminação da infecção, permitindo que a gravidez tenha chegado a termo, com um parto vaginal, sem intercorrências.

Spontaneous Perforation of Pyometra

Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.

Pyometra in Elderly Patients and Its Clinical Characteristics

BACKGROUND: Pyometra should be treated with caution in elderly patients because it may indicate a malignancy in the post-menopausal period and can result in life-threatening complications such as septicemia or pan-peritonitis. METHODS: We retrospectively analyzed the clinical features of 30 patients aged ≥65 years who received treatment for pyometra between January 2010 and December 2014. RESULTS: The 30 patients (age: median, 74 years; range, 66-88 years) were evaluated. They presented with vaginal discharge (n=17), vaginal bleeding (n=8), abdominal pain (n=6), or fever (n=3). The most common accompanying systemic disease was hypertension (n=15), followed by diabetes mellitus (n=10). Of the 30 cases, seven were associ- ated with gynecologic malignancy (cervical cancers, n=3; endometrial cancers, n=3; and ovarian cancer, n=1); and 14, with gynecologic benign diseases (uterine myoma, n=5; cervical intraepithelial neoplasia, n=4; tubo-ovarian abscess, n=3; endometrial polyp, n=1; uterine prolapse, n=1). All the patients were treated with cervical dilatation and drainage. Fifteen patients underwent gynecologic surgery with antibiotic therapy, and 15 received empirical antibiotic treatment alone. Two women experienced spontaneous perforation of pyometra. Pyometra is considered a complication of benign and malignant gynecologic disease, until proven otherwise. CONCLUSION: In elderly patients with comorbidities, pyometra might induce severe complications such as pan-peritonitis or sepsis. Early accurate diagnosis is important to determine an appropriate individualized treatment to reduce morbidity and mortality.

Experiences in Diagnosis and Treatment of 31 Cases of Uterine Empyema / 昆明医科大学学报

Objective To investigate the etiology,clinical characteristics,diagnosis and treatment of female uterine empyema.Methods We retrospectively analyzed the clinical data of 31 patients with uterine empyema in our hospital from January 2003 to December 2015.Results Uterine empyema was caused as a result of occlusion of the cervical canal,Patients had no typical symptoms,four cases had no symptoms (12.90％),twenty-two cases had abdominal pain (70.97％),twenty-seven cases had vaginal discharge (98.09％) and twelve cases had sanguinopurulent material (38.71％),three cases of them had fever (9.70％).Gynecological ultrasound examination was an important diagnostic tool.Dilatation of cervix,discharging purulent material,antibiotics treatment,the cervical adhesions were manually broken down to establish a patent cervical lumen to accommodate a uterine Fleischl catheter,the uterus was lavaged with 0.9％ Nacl solution,metronidazole,gentamicin.The above treatment got a good therapeutic effect.Conclusion Pyometra has atypical symptoms with difficult diagnosis,and develops gradually.Gynecological ultrasound examination has great clinical significance.Full dilatation of cervix,discharging purulent material are the key to the success of conservation treatment and can achieve good results.Combination of endometrial cancer or other malignant tumor patients should take surgery as soon as possible,according to the tolerance ability.