Successful Delivery After Myomectomy for Spontaneous Ruptured Pyomyoma: A Case Report and Literature Review

Abstract

In this article, we report a case of spontaneous ruptured pyomyoma during pregnancy with successful delivery after myomectomy. A 35-year-old pregnant female (27 weeks of gestation) presented with lower abdominal pain. The patient had a history of uterine fibroids. Ultrasound, computed tomography, and magnetic resonance imaging confirmed a spontaneous ruptured pyomyoma (maximum diameter: 12.6 cm). Myomectomy was performed, and her abdominal distension and pain were significantly improved within 1 day; the condition of the fetus was normal. One month after surgery, severe tenderness was detected in the lower right side of the uterus. Considering the higher risk of uterine rupture and associated complications, a cesarean section was performed. The mother and neonate were discharged 3 and 42 days after delivery, respectively, in good condition. Myomectomy for spontaneous ruptured pyomyoma during pregnancy may be feasible and extend gestational age to improve outcomes for the mother and neonate.

Keywords: Abdominal pain; Case report; Myomectomy; Pregnancy; Pyomyoma.

Figure 1

Ultrasound examination of subserosal uterine fibroids on the right wall. A The second-trimester ultrasound revealed a hypoechoic area in the anterior wall of the uterine myometrium, suggesting the possibility of uterine fibroids. B–D Computed tomography and E and F Magnetic resonance imaging confirmed the presence of a giant uterine fibroid. Arrows indicate local thinning of the right myometrium (5 cm represents the indication of measuring scale). HAR: Head anterior right. RPF: Right posterior foot. FPL: Foot posterior left. AFR: Anterior foot right. PHL: Posterior head left.

Figure 2

Intraoperative investigation. A Degenerated uterine fibroid covered by the greater omentum. B Posterior wall of the pyomyoma with pus and necrosis leaking from the ulceration. C Cross-section of the uterine fibroid with a maximum diameter of 12.6 cm.