Huge pyometra in a postmenopausal age: a diagnostic dilemma

Yadav, Pratiksha; Datar, Nikhil; Poddar, Pabashi; Chavan, Komal; Saraogi, R. M.

doi:10.18203/2320-1770.ijrcog20150743

Cited by 5 publications

(5 citation statements)

References 2 publications

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“…These causes need to be treated promptly. Of these, idiopathic causes account for 74.1% of cases, genital tract anomalies for 3.7% of cases, and cancers for 22.2% of cases [ 10 ]. To exclude concomitant cancers, a thorough pelvic examination and history should be performed after a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Pyometra Puzzler: Unraveling Senile Endometritis in an Unconventional Presentation

Reddy,

Agrawal,

Jaiswal

et al. 2024

Cureus

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Pyometra is a very uncommon condition in postmenopausal women that rarely improves with standard antibiotic treatments. It is usually overlooked as the patient presents with vague symptoms. Our case presented a postmenopausal woman with sepsis due to a huge pyometra. Swabs for sensitivity, tubercular gene testing, and basic blood workup were done, and the patient was started on intravenous antibiotic therapy. Pyometra drainage could not be done due to thin, friable uterine walls. When the patient had improved, a clinically total abdominal hysterectomy was done after ruling out malignant causes. Delay in the diagnosis of this condition may lead to perforation, which may, in turn, cause peritonitis, which may gravely affect the patient.

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Section: Discussionmentioning

confidence: 99%

Pyometra Puzzler: Unraveling Senile Endometritis in an Unconventional Presentation

Reddy,

Agrawal,

Jaiswal

et al. 2024

Cureus

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“…The common causes of pyometra in postmenopausal age include malignancy of the genital system including post-radiotherapy complications, benign conditions such as an endometrial polyp, senile endometritis, idiopathic conditions leading to cervical stenosis, or postoperative infection. Out of these, 22.2% of cases are associated with malignancies, 3.7% with genital tract abnormalities, and 74.1% are due to idiopathic causes [3]. The classic triad of clinical manifestations includes lower stomach pain, postmenopausal hemorrhage per vaginum, and purulent vaginal discharge.…”

Section: Discussionmentioning

confidence: 99%

“…A study by Chauhan A et al shows the median age of presentation to be 65 years, and only less than one-third of cases are linked to an underlying malignancy [2]. Some other causes of such huge pyometra may be foreign bodies, puerperal infections, and uterine anomalies [3]. Bacteremia, sepsis, and spontaneous uterine rupture that results in widespread peritonitis are the three main adverse effects of pyometra.…”

Section: Introductionmentioning

confidence: 99%

Massive Pyometra Due to Senile Endometritis in a Postmenopausal Woman: A Rare Entity

Waghe¹,

Acharya²,

Potdar³

et al. 2022

Cureus

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An 83-year-old postmenopausal female P5L5 (all full-term normal deliveries) presented with complaints of foul-smelling purulent discharge per vagina for 15 days associated with pain in abdomen. A midline mass was palpable per abdomen in the suprapubic region corresponding to 16 weeks size gravid uterus, which was soft to firm in consistency. On examination per vaginum, the atrophied cervix was found flush with the vagina and purulent discharge was seen draining through the cervix. Blood reports showed raised total leucocyte count with granulocyte predominance. Abdominal ultrasonography revealed a uterine cavity filled with echogenic contents, with no abdominal cavity collection. The patient was started on IV antibiotics and planned for dilatation and curettage. On histopathology acute on chronic senile endometritis was found with no evidence of malignant cells. Tuberculosis gene testing was found to be negative. We conclude that the senile endometritis leading to cervical stenosis as seen during dilatation and curettage had led to the pyometra and no evidence of malignancy was found.

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“…2,4 The incidence increases to 1.5%-4% in the setting of uterine or cervical malignancy. 5 While the classically described presentation includes abdominal pain, fever, and vaginal discharge/vaginal bleeding, 6 clinical presentation varies. It has been reported that over 50% of women with unperforated pyometra may be asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Pyometra: An Atypical Cause of Abdominal Pain

Walthall

Heincelman

2021

Journal of Investigative Medicine High Impact Case Reports

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Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

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Huge pyometra in a postmenopausal age: a diagnostic dilemma

Cited by 5 publications

References 2 publications

Pyometra Puzzler: Unraveling Senile Endometritis in an Unconventional Presentation

Pyometra Puzzler: Unraveling Senile Endometritis in an Unconventional Presentation

Massive Pyometra Due to Senile Endometritis in a Postmenopausal Woman: A Rare Entity

Pyometra: An Atypical Cause of Abdominal Pain

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