Kiritta Richard, Balyorugulu Georgina, Ahmed Maimuna, Christopher Frank, Miltenburg Andrea Solnes, Kihunrwa Albert
Department of Obstetrics and Gynecology, Bugando Medical Centre, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Department of Pediatrics, Bugando Medical Centre, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
J Med Case Rep. 2020 Dec 7;14(1):237. doi: 10.1186/s13256-020-02543-1.
Pyometrocolpos is accumulation of infected fluid in the uterus and vagina. It is rare in children, mostly seen after menarche as a result of obstructive congenital genital malformation that impairs free drainage of the uterine secretions. In a child, it may present as an acute illness that necessitates urgent and appropriate management and treatment of the underlying cause, which can be a challenge in a resource-limited setting.
We report a case of pyometrocolpos in an 8-month-old African infant who presented with fever, vomiting, decreased urine output, and abdominal distension of 12 days' duration. An abdominal examination revealed a subumbilical midline incision scar and a midline lower abdominal mass. She appeared to have presented at the emergency department with similar complaints 2 months earlier and had been diagnosed with pyometra, which was managed by emergency laparotomy for pus drainage, and she was kept on antibiotics. Recovery was established after 10 days of admission, and the patient was discharged to home. Her symptoms reappeared 2 months after the first presentation. Her blood work showed significant leukocytosis with neutrophilia, and abdominal ultrasound depicted bilateral hydronephrosis with hydroureters and a fluid-filled uterus. Examination under anesthesia in the operating theater revealed normal-looking female genitalia with a cribriform hymen, beneath which lied a transverse vaginal septum. Foul-smelling pus was aspirated through the septum, and septectomy was performed to allow 350 ml of pus to drain. A pus sample was sent for culture and sensitivity, and Escherichia coli sensitive to ceftriaxone and gentamicin was isolated.
Pyometrocolpos is rare in childhood but should be suspected in a girl presenting with a midline lower abdominal mass accompanied with urinary obstructive symptoms associated with fever and gastrointestinal symptoms. Escherichia coli seems to be the most probable offending organism, but pus culture is crucial for antibiotic stewardship in proper management of the infection. Definitive treatment should focus on correcting the obstructive anatomical congenital deformity that caused the obstruction in order to avoid recurrence.
子宫阴道积脓是指子宫和阴道内积聚感染性液体。在儿童中较为罕见，大多在初潮后出现，是由先天性梗阻性生殖器畸形导致子宫分泌物无法自由引流所致。在儿童中，它可能表现为急性疾病，需要对潜在病因进行紧急且恰当的处理和治疗，这在资源有限的环境中可能是一项挑战。
我们报告一例8个月大的非洲婴儿子宫阴道积脓病例，该婴儿出现发热、呕吐、尿量减少以及持续12天的腹胀。腹部检查发现脐下中线切口瘢痕和下腹部中线肿块。她似乎在2个月前因类似症状到急诊科就诊，当时被诊断为子宫积脓，通过急诊剖腹手术引流脓液，并接受抗生素治疗。入院10天后康复出院。首次就诊2个月后症状再次出现。血液检查显示白细胞显著增多伴中性粒细胞增多，腹部超声显示双侧肾盂积水伴输尿管积水以及充满液体的子宫。在手术室麻醉下检查发现女性生殖器外观正常，处女膜呈筛状，其下方有一横隔阴道。通过隔膜抽出恶臭脓液，并进行隔膜切除术，使350毫升脓液得以引流。采集脓液样本进行培养和药敏试验，分离出对头孢曲松和庆大霉素敏感的大肠杆菌。
子宫阴道积脓在儿童期罕见，但对于出现下腹部中线肿块并伴有与发热和胃肠道症状相关的尿路梗阻症状的女孩应予以怀疑。大肠杆菌似乎是最可能的致病微生物，但脓液培养对于感染的恰当管理中抗生素的合理使用至关重要。明确的治疗应着重纠正导致梗阻的先天性梗阻性解剖畸形，以避免复发。
