Gynecology - Obstetrics Department, General Hospital of Pella, Hospital Unit of Edessa, Greece.
Ger Med Sci. 2022 Jun 14;20:Doc09. doi: 10.3205/000311. eCollection 2022.
Pyometra is a rare gynecological condition and is characterized by pus accumulation in the uterine cavity. It occurs more frequently in postmenopausal women than tubo-ovarian abscesses, which constitute a more common gynecological complication among premenopausal women.
A 72-year-old woman was admitted to our emergency department with lower abdominal pain, diarrhea and fever for the last three days. The laboratory results were indicative to sepsis. The clinical examination revealed sensitivity by palpation of the lower abdomen without any signs of acute abdomen. The gynecological assessment showed pus outflow through the cervix and a pus culture was done. The ultrasound examination found an enlarged uterus, full of hypoechoic fluid, unclear borders between endometrium-myometrium, a mixed echogenicity adnexal mass and no free fluid in the pouch of Douglas. A computed tomography (CT) of the abdomen showed the presence of pyometra and a tubo-ovarian abscess of the right adnexa.
The patient was treated with intravenous antibiotic therapy. When the patient was hemodynamically stable and afebrile, she underwent ultrasound-guided dilatation and curettage of the cervical canal and the endometrium in order to exclude an underlying malignancy, under general anesthesia.
The patient responded promptly to the intravenous antibiotic therapy which was adapted to the pus culture result. The laboratory results withdrew to normal values and the patient was discharged after fifteen days of hospitalization in an afebrile and hemodynamically stable condition.
Pyometra and tubo-ovarian abscess in postmenopausal women could be a lethal complication of pelvic inflammatory disease. The key in treatment is the dilatation of the cervix and drainage of the pyometra. The administration of intravenous antibiotics and drainage through the cervix could be a suitable method of treatment for pyometra in older patients or those with poor performance status if only the histological examination is negative for malignancy.
子宫积脓是一种罕见的妇科疾病，其特征是子宫腔内脓液积聚。它在绝经后妇女中比输卵管卵巢脓肿更为常见，后者是绝经前妇女中更为常见的妇科并发症。
一名 72 岁妇女因下腹疼痛、腹泻和发热三天而被收入我院急诊科。实验室结果提示感染性休克。临床检查显示下腹触诊敏感，但无急腹症迹象。妇科评估显示宫颈有脓液流出，并进行了脓液培养。超声检查发现子宫增大，充满低回声液，子宫内膜-肌层边界不清，附件区混合回声肿块，Douglas 窝内无游离液体。腹部计算机断层扫描（CT）显示子宫积脓和右侧附件输卵管卵巢脓肿。
患者接受静脉抗生素治疗。当患者血流动力学稳定且不发热时，在全身麻醉下经超声引导行宫颈和子宫内膜扩张和刮宫术，以排除潜在的恶性肿瘤。
患者对静脉抗生素治疗反应迅速，根据脓液培养结果进行了调整。实验室结果恢复正常，患者在发热和血流动力学稳定的情况下住院 15 天后出院。
绝经后妇女的子宫积脓和输卵管卵巢脓肿可能是盆腔炎的致命并发症。治疗的关键是宫颈扩张和引流子宫积脓。如果组织学检查排除恶性肿瘤，静脉抗生素治疗和经宫颈引流可能是老年患者或身体状况不佳患者治疗子宫积脓的合适方法。
