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Cureus Oct 2022Generalized peritonitis with sepsis is a common general surgery emergency. The most likely implicated structure for generalized peritonitis with pneumoperitoneum is the...
Generalized peritonitis with sepsis is a common general surgery emergency. The most likely implicated structure for generalized peritonitis with pneumoperitoneum is the gastrointestinal tract with urgent explorative laparotomy being the most definitive treatment. In this particular case, perforated diverticulitis was suspected and upon an exploration of the abdomen, frank pus in the setting of normal colon was noted. Some common differential diagnoses for frank pus in the abdomen include viscus perforation, pancreatic necrosis, gangrenous cholecystitis, or penetrating abdominal trauma. Here, we report a rare occurrence of peritonitis secondary to uterine rupture from pyometra.
PubMed: 36348865
DOI: 10.7759/cureus.29938 -
Medicina (Kaunas, Lithuania) Mar 2023Pyometra is a uterine infection that causes pus to accumulate in the uterine cavity. Pyometra primarily affects postmenopausal women. Multiple aetiologies, including...
Pyometra is a uterine infection that causes pus to accumulate in the uterine cavity. Pyometra primarily affects postmenopausal women. Multiple aetiologies, including cervical stenosis, have been identified. Medical therapy using intravenous antibiotics and surgical evacuation are the conventional treatment options for pyometra. Here, we present a unique case of a novel therapy for pyometra in a geriatric patient; percutaneous alleviation of the causative cervical stenosis was performed using balloon dilatation, along with endometrial drainage of the infected fluid through her vagina, a natural route. This technique has overcome the need for other invasive therapies. The patient's clinical condition improved significantly after this minimally invasive treatment. Percutaneous balloon dilatation of the cervix for stenosis or occlusion in patients with pyometra facilitates drainage of the infected endometrial fluid. This alternative management technique ensured a satisfactory postoperative course and tolerance in the short-term follow-up. Furthermore, the technique ensured good aesthetic results, with its minimally invasive approach in selected patients, compared to other means of evacuation.
Topics: Humans; Female; Aged; Pyometra; Constriction, Pathologic; Uterus; Vagina; Drainage
PubMed: 37109647
DOI: 10.3390/medicina59040689 -
Topics in Companion Animal Medicine 2022The objective of the study was to ascertain the role of prostaglandins Viz., PGE and PGF, and their respective receptors in the pathophysiology of canine pyometra....
The objective of the study was to ascertain the role of prostaglandins Viz., PGE and PGF, and their respective receptors in the pathophysiology of canine pyometra. Normal (n = 6) and pyometra (n = 8) affected uterus were collected from bitches undergoing ovariohysterectomy. Pyometra was graded according to histopathological alterations. The levels of PGE and PGF were estimated in the endometrium. The differential expression in the mRNA of PGF receptor (FP) and PGE receptors (EP1, EP2, EP3, and EP4) were studied in the endometrium and myometrium of the pyometra-affected uterus. Normal uterus served as calibrator. Elevation of both PGE and PGF levels in the endometrium of pyometra-affected bitches was observed. The FP receptor gene in the endometrium and myometrium of pyometra-affected bitches was downregulated (P < .05). Out of all EP receptors, only EP2 receptor has shown upregulation in both endometrium and myometrium of pyometra affected uterus. EP3 receptor got downregulated in both endometrium and myometrium in pyometra. Thus, downregulation of FP, EP3 receptors in the myometrium reinforces the lack of contractility in pyometra-affected bitches favoring bacterial proliferation and subsequent pus accumulation. Moreover, upregulation of EP2 receptors in the pyometra bitches suggests the scope of selective pharmacological inhibition of EP2 receptors as an adjunct therapy in the treatment of pyometra.
Topics: Animals; Dinoprostone; Dog Diseases; Dogs; Female; Pyometra; Receptors, Prostaglandin; Receptors, Prostaglandin E; Uterus
PubMed: 34742880
DOI: 10.1016/j.tcam.2021.100612 -
Journal of Pediatric and Adolescent... Oct 2020Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. It rarely occurs in premenopausal patients, particularly adolescents.
BACKGROUND
Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. It rarely occurs in premenopausal patients, particularly adolescents.
CASE
A 16-year-old girl with multiple comorbidities including severe intellectual disability, neurogenic bladder, and recurrent urinary tract infection presented with fever, abdominal pain, and vaginal discharge after prolonged treatment with depot medroxyprogesterone acetate. Ultrasound imaging showed an intrauterine fluid collection consistent with hematometra; however, hysteroscopic evaluation confirmed pyometra, which was evacuated using a suction curette. Despite postoperative antibiotic therapy, she re-presented with similar findings requiring additional hysteroscopic evaluation and evacuation. After a third evacuation, an intrauterine catheter was placed to aid in drainage. This was not tolerated by the patient, and she ultimately required total laparoscopic hysterectomy for definitive management, which was performed without incident.
SUMMARY AND CONCLUSION
Pyometra is a rare occurrence that typically presents after menopause; however, it should be considered in patients with poor genitourinary hygiene and medically induced endometrial atrophy. In severe cases, hysterectomy might be required for definitive management.
Topics: Adolescent; Drainage; Female; Humans; Hysterectomy; Pyometra; Ultrasonography
PubMed: 32574600
DOI: 10.1016/j.jpag.2020.06.009 -
The Journal of Reproductive Medicine 2015To review the clinical profiles and management outcomes of patients with pyometra.
OBJECTIVE
To review the clinical profiles and management outcomes of patients with pyometra.
STUDY DESIGN
A retrospective review of all women admitted with a confirmed diagnosis of pyometra over an 8-year period (January 2003 to December 2010). The medical records, including operation notes, histological and microbiological results, were reviewed.
RESULTS
A total of 57 patients accounting for 76 admissions were identified. The mean patient age was 82.0 ± 11.3 years. The most common presenting symptom was postmenopausal bleeding (59.2%), followed by vaginal discharge (40.8%), fever (6.6%), and abdominal pain (5.3%). Drainage of pyometra was either by uterine Foley catheter insertion (48 patients [84.2%]) or repeated endometrial aspiration (2 patients [3.5%]). Antibiotics were prescribed to 49 patients (86.0%). Diagnostic hysteroscopy with mechanical cervical dilation was performed in 6 patients (10.5%). Gynecological malignancy was identified in only 1 patient, while colorectal cancer was identified in 2 patients. No patient had spontaneous uterine perforation or sepsis. Sixteen patients had recurrent pyometra within a mean follow-up period of 5.1 ± 5.8 months (range, 0.5-23 months).
CONCLUSION
Pyometra usually presents with postmenopausal bleeding and can be treated with drainage and antibiotics treatment. In contrast to previous reports, our study indicates that spontaneous uterine perforation and gynecological malignancies are not commonly associated with pyometra.
Topics: Aged; Aged, 80 and over; Female; Hong Kong; Humans; Pyometra; Retrospective Studies
PubMed: 26380492
DOI: No ID Found -
Fukushima Journal of Medical Science Apr 2020We describe two cases of spontaneously perforated pyometra (SPP) in elderly women treated with two different surgical approaches. An 88-year-old woman underwent... (Review)
Review
Generalized peritonitis secondary to spontaneously perforated pyometra in elderly women:two cases with different clinical courses and surgical approaches and review of the literature.
We describe two cases of spontaneously perforated pyometra (SPP) in elderly women treated with two different surgical approaches. An 88-year-old woman underwent emergency laparotomy for presumed diagnosis of gastrointestinal (GI) tract perforation. During surgery, SPP and a tumor of the sigmoid colon were identified. Total hysterectomy and sigmoid colon resection were performed. Despite exhaustive postoperative treatments, the patient died on postoperative day (POD) 189 due to peritonitis and pneumonia. A 93-year-old woman with acute abdomen was diagnosed with severe pyometra and primarily treated with transcervical drainage. Due to progression of generalized peritonitis, laparoscopic surgery was performed. Intraoperatively, scar from a uterine body perforation was identified, leading to the diagnosis of SPP. Only peritoneal irrigation and drainage were performed, in consideration of her advanced age. She improved and was discharged from the hospital on POD 35. The prognosis for SPP is sometimes poor, especially in older women. Minimally invasive surgical intervention might be considered for primary treatment in such cases.
Topics: Aged, 80 and over; Female; Humans; Peritonitis; Pyometra; Uterine Perforation
PubMed: 32281585
DOI: 10.5387/fms.2019-30 -
Veterinary Pathology Nov 2022Endometrial hyperplasia (EH) is a pathologic condition of the uterus with increased endometrial gland to stroma ratio compared to normal cyclic uterine proliferation. In...
Endometrial hyperplasia (EH) is a pathologic condition of the uterus with increased endometrial gland to stroma ratio compared to normal cyclic uterine proliferation. In domestic animals, EH often involves cystic distension of proliferating endometrial glands and may be concurrent with pyometra. In large captive nondomestic felids, an association between EH and pyometra is common; however, detailed species differences between the histological uterine findings in lions () and tigers () and clinical manifestations have yet to be described. Uterine sections from 14 lions and 24 tigers with EH and/or pyometra were scored for several histological parameters and clinical histories were recorded. The percentage of endometrium affected by hyperplasia, endometrial gland to stroma ratio, and adenomyosis were significantly ( = .0385, = .0008, and = .0463, respectively) more severe in lions compared to tigers as univariate analytes. Although tubular complexity was not statistically significant ( = .3254), when combined as a proposed EH grading scheme, these 4 features confirmed lions had significantly ( = .0068) more severe EH compared to tigers. Endometrial hyperplasia severity significantly correlated with inflammation/pyometra severity when controlling for species ( = .0203). A significant correlation exists between pyometra-associated clinical sign severity and the presence of pyometra in tigers, ( = .0026) but not in lions ( = .1144). There was no statistical difference in the severity of clinical signs associated with pyometra between these species ( = .1986). This proposed grading scheme may have clinical utility in providing a more consistent and objective evaluation of EH in large captive felids.
Topics: Animals; Animals, Zoo; Endometrial Hyperplasia; Felidae; Female; Lions; Pyometra; Tigers
PubMed: 35787088
DOI: 10.1177/03009858221109094 -
Journal of Menopausal Medicine Apr 2016Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5%...
Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.
PubMed: 27152313
DOI: 10.6118/jmm.2016.22.1.47 -
The Journal of Emergency Medicine May 2016Pyometra is defined as an accumulation of purulent material in the uterine cavity. Spontaneous perforation is a very rare complication of pyometra. The clinical findings... (Review)
Review
BACKGROUND
Pyometra is defined as an accumulation of purulent material in the uterine cavity. Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen.
CASE REPORT
We report a rare and difficult case of peritonitis in an elderly female that was caused by a spontaneous perforation of pyometra. A 90-year-old postmenopausal woman was referred to our hospital with complaints of vomiting, fever, and abdominal pain. Computed tomography revealed a large amount of ascites, cystic mass in the uterus, and intraperitoneal and intrauterine air. Transvaginal ultrasound demonstrated a thin area around the fundus. An emergency laparotomy was performed for the suspected gastrointestinal perforation or perforation of pyometra. At laparotomy, copious purulent fluid was present in the peritoneal cavity; however, no perforation of the gastrointestinal tract was observed. We identified a perforation site over the uterine fundus and purulent material exuding from the cavity. Subsequently, hysterectomy and bilateral salpingo-oophorectomy were performed. The patient was discharged on postoperative day 13 with no complications. Histopathologic studies revealed endometritis and myometritis with no evidence of malignancy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With diffuse peritonitis, ruptured pyometra should be considered, even in elderly female patients. This case illustrates the importance of clinical knowledge of acute gynecologic diseases. Here we also review the perforation of pyometra with no evidence of malignancy.
Topics: Abdominal Pain; Aged, 80 and over; Ascites; Emergency Service, Hospital; Escherichia coli; Female; Fever; Humans; Laparotomy; Ovariectomy; Peptostreptococcus; Peritonitis; Pyometra; Salpingectomy; Spontaneous Perforation; Ultrasonography; Uterus; Vaginal Discharge; Vomiting
PubMed: 26994838
DOI: 10.1016/j.jemermed.2016.01.024 -
Singapore Medical Journal Sep 2019A 92-year-old woman presented to the emergency department with urinary symptoms, fever and suprapubic tenderness. Her inflammatory markers were raised. Urine and blood...
A 92-year-old woman presented to the emergency department with urinary symptoms, fever and suprapubic tenderness. Her inflammatory markers were raised. Urine and blood cultures were negative. Computed tomography performed to look for a source of sepsis showed distension of the uterine cavity with high-attenuation fluid, an air-fluid level and gas locules along the uterine wall. The causes, clinical presentation and imaging features of pyometra are discussed.
Topics: Aged, 80 and over; China; Diabetes Complications; Emergency Service, Hospital; Female; Fever; Humans; Hypertension; Inflammation; Leiomyoma; Middle Aged; Myocardial Ischemia; Necrosis; Peritonitis; Pyometra; Sepsis; Tomography, X-Ray Computed; Ultrasonography; Uterus
PubMed: 31570949
DOI: 10.11622/smedj.2019113