Medical Management of Pyometra in the Delayed Postoperative Period

Abstract

Pyometra is a rare condition in which purulent material becomes entrapped within the uterine cavity. If unrecognized in a timely fashion, life-threatening complications can arise. The following is a case report of a 50-year-old female who presented to the emergency department with abdominal pain and heavy vaginal bleeding. She was diagnosed with a pyometra based on imaging and treated conservatively with antibiotics. The patient ultimately had an uncomplicated hysterectomy with resolution of normal female pelvic anatomy prior to surgery. Pyometra should be considered when women present with diffuse abdominal pain or peritonitis. As demonstrated in this report, early detection and conservative management may help prevent serious complications such as uterine perforation, lead to shorter hospital stays, and result in safer operative management.

Figure 1

Transvaginal ultrasound performed in clinic for evaluation of abnormal uterine bleeding. Endometrial thickness was noted to be 4.70 mm with a uterine length of 9.1 cm and width of 8.2 cm.

Figure 2

CT scan with contrast at time of presentation to the emergency department. Gas fluid collection was noted to measure up to 13 cm in length, 6 cm in width, and 5 cm in height. Findings concerning for abscess/pyometra.

Figure 3

Transvaginal ultrasound performed in the emergency department. Foul-smelling discharge noted in addition to heterogeneous material and air within the uterus.

Figure 4

Pelvic anatomy at the time of hysterectomy, bilateral salpingectomy. Minimal adhesions noted and uterus did not appear enlarged.