Abstract Case

7/21/2019 Abstract Case

http://slidepdf.com/reader/full/abstract-case-56e029678e60f 1/3

Pyometra in A Postmenopausal Women: A Case Report

Rosalina, Amir Fauzi

Department of Obstetric and Gynaecology

Faculty of edicine !ri"i#aya $ni%ersitydr& o'ammad (oesin (ospital Palembang

Abstract

Pyometra is an uncommon disease, it refers to accumulation of purulent material

in the uterine cavity. Its reported incidence is 0.01-0.5% in gynecologic patients.

Mostly occurs at postmenopausal women. irst case of pyometra was reported !y

"ohn and #lar$e in ondon at 1&1'. (he most common cause of pyometra is

malignant disease of genital tract and the conse)uences of their treatment

*radiotherapy+. ther causes are !enign tumor li$e leiomyoma, endometrial

polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, andcongenital cervical anomalies. (he classic symptoms of pyometra *lower

a!dominal pain, purulent vaginal discharge, and enlarged of uterus+ are

nonspecific and fre)uently misdiagnosed !y other cause of acute a!domen.

e present a case of pyometra in a 0 year old postmenopausal women, presented

with acute a!dominal pain. /mergency eplorative laparatomy was performed

under the diagnosis of torsion of the ovarian cyst. (otal hysterectomy with

!ilateral salphingo-oophorectomy was performed. istopathologic result revealed

an endometritis caused !y fungal infection. #ulture of pus from uterine cavity

grew Pseudomonas cepacia.

)ey "ords2 Pyometra, postmenopausal women, acute a!domen, endometritis

*+ROD$C*O+

Pyometra is an uncommon disease, it refers to accumulation of purulent material

in the uterine cavity. Its reported incidence is 0.01-0.5% in gynecologic patients.

Mostly occurs at postmenopausal women. irst case of pyometra was reported !y

"ohn and #lar$e in ondon at 1&1'. (he most common cause of this condition is

interference with the normal drainage of the uterus !y malignant disease. ther

causes are !enign tumor li$e leiomyoma, endometrial polyps, senile cervicitis,

cervical occlusion after surgery or irradiation, puerperal infections, and congenital

cervical anomalies. (he classic symptoms of pyometra *lower a!dominal pain,

purulent vaginal discharge, and enlarged of uterus+ are nonspecific and fre)uently

misdiagnosed !y other cause of acute a!domen. 3pontaneous rupture of the uterus

is rare, !ut may occur following the formation of pyometra.



CA!- R-POR

4 0 year old postmenopausal women, presented with lower a!dominal pain of 1

wee$ duration. (he pain !ecame severe one day !efore she was admitted to our

hospital. (he menopause had occurred at the age of years. 3he had no history

of postmenopausal !leeding or vaginal discharged, !ut she had suffered from

rheumatoid arthritis and for several years had !een ta$ing non steroid anti

inflammatory drugs dan corticosteroid.

n the physical eamination, she loo$ed moderately ill2 her !lood pressure

was 1'06&0 mmg, pulse rate 7& !eats6min, and aillary temperature was 89,7 0#.

er a!domen was soft and not distended, !owel sounds were normal. Pelvic

eamination revealed a cystic mass, diameter 10& cm with adhesion. (he uterine

corpus at normal range, and parametrium was tender.

(he results of la!oratory studies on admission were as follows2 white !lood

cell count 175006mm8 with &% segs, sedimentation rate 75 mm6hr, and

hemoglo!in 7,& g6d. Pelvic ultrasound revealed a cystic mass, diameter 10& cm,

hipoechoic, monoloculare, with thic$ wall: uterine was could not !e identification.

(he conclusion was ovarian cyst.

/mergency eplorative laparotomy was performed under the diagnosis of

torsion of the ovarian cyst. Intra operatif, there was adhesion of the uterus with

ad;acent structure. (he uterus was soft and enlarged, and was found to have a

necrotic area at fundal. 4t the time of eploration, necrotic area !ecame perforated

and a!out 500 cc of purulent material ecluding. (he fallopian tu!es and ovaries

were normal. 4 total a!dominal hysterectomy and !ilateral salphingo-

oophorectomy were performed. #ulture of the pus grew Pseudomonas cepaciathat sensitive to cefepime, cotrimoa<ole, and sulfonamide. istological

eamination revealed an endometritis and myometritis caused !y fungal infection,

no evidence of malignancy.

Postoperatively, intensive intravenous antibiotic therapy with

Sulperazone and metronidazole was performed for 3 days,



continued with oral antibiotic. She recovered well and was

discharged on the 8th postoperative day.

DISCUSSION

Pyometra, or pyometrium, is defined as the accumulation of pus in the uterine

cavity resulting from interference with its natural drainage. Pyometra is common

in postmenopausal women, and more than 50% of all patients of nonruptured

pyometra are asymptomatic. (he incidence of pyometra !ecomes much higher

with age and decline in activity. Postmenopausal !leeding, vaginal discharge,

uterine enlargement, and cramping pain are said to !e the classic symptoms of

pyometra, only !leeding and discharge were commonly reported in these cases !ut

this patient had no vaginal !leeding or discharge.

=arious malignant and !enign diseases have !een shown to cause pyometra.

(he most common cause of pyometra is malignant disease of genital tract and the

conse)uences of their treatment *radiotherapy+. ther causes are !enign tumor

li$e leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after

surgery, puerperal infections, and congenital cervical anomalies. 4 detailed pelvic

eamination should !e performed to rule out the associated malignancies.

istological eamination of the uterus in our case revealed no evidence of

malignancy, myomata or other a!normality ad;acent to the site of the rupture.

ong term steroid therapy would however have predisposed her to infection

which may have caused the tissues to !ecome more fria!le as the infection

invaded the myometrium

(he diagnosis of pyometra is difficult, !ecause it is usually asymptomatic.

>uptured pyometra should !e $ept in mind in elderly women presenting withacute a!domen as an unusual !ut serious condition.

Documents

Abstract Case