Pyomyoma as a Rare Source of Postpartum Sepsis

DeMaio, Alison; Doyle, Miriam

doi:10.1155/2015/263518

Cited by 11 publications

(11 citation statements)

References 3 publications

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“…If the patient had a high fever, pyomyoma should be seriously considered. [ 12 ] When the myoma was expelled into the vagina, blunt and sharp dissection through the vagina would usually work. [ 7 ] If the root of the myoma was too broad or if there was a severe bleeding during the dissection, laparotomy or laparoscopy could be considered.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous expulsion of a huge cervical leiomyoma from the vagina after cesarean

2018

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Rationale:As more and more women delay their child bearing age, the prevalence of uterine fibroids during pregnancy is likely to increase.Patient Concerns & Lessons:We report a Chinese Tibetan case with spontaneous expulsion of a huge cervical myoma after cesarean. Decreased blood supply of the myoma and the uterine contraction may contribute to the spontaneous expulsion. Vaginal-myomectomy is recommended as the initial treatment.

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Section: Discussionmentioning

confidence: 99%

Spontaneous expulsion of a huge cervical leiomyoma from the vagina after cesarean

2018

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“…Sometimes an acute abdomen may occur, which is potentially due to serious complications such as a ruptured pyomyoma [ 19 ], peritonitis and sepsis. Thus, the combination of known fibroids with sepsis in the absence of other sources of infection for bacteremia should lead to a strong clinical acumen and a high index of suspicion of pyomyoma [ 5 , 7 ]. The differential diagnosis of pyomyoma includes any pelvic mass associated with signs of infection (pyometra, tuboovarian abscess), malignancy, degenerated leiomyoma, and ectopic infection [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pyomyoma, also known as suppurative leiomyoma, is an unusual condition resulting from infarction, necrosis and secondary infection of fibroids [1] that can lead to fatal complications if not promptly diagnosed and treated [2]. It often develops in the puerperal or postmenopausal period [2,3]; and only twelve cases have been reported during the postpartum period since 1945, but all cases can be accompanied by a suppurative process that develops insidiously [2,[4][5][6]. Pyomyoma can manifest with a classic triad of symptoms, including abdominal pain, sepsis without any obvious origin of bacteremia and a history of leiomyoma [7].…”

Section: Introductionmentioning

confidence: 99%

Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids

Wang

Sun

2021

BMC Pregnancy Childbirth

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Background Pyomyoma is an unusual fibroid that usually develops during the puerperal or postmenopausal period. If not promptly diagnosed and treated, it can become life threatening. Although various conservative and surgical therapies have been discussed in the literature for this condition, there are very few reports related to the management of prolapsed pedunculated submucosal myoma. Case presentation In this case report, an intramural fibroid transformed into a pedunculated submucosal pyomyoma, which prolapsed into the vagina after a miscarriage and caused life-threatening toxic shock. Apart from prompt antibiotic treatment, a transabdominal myomectomy rather than hysterectomy was performed due to the very large diameter of the pyomyoma. As a result, fertility was preserved, and the patient conceived naturally and delivered a healthy baby two years later. Discussion and conclusions It is important to maintain strong clinical suspicion for pregnant or postpartum women with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma. Timely recognition and prompt surgical treatment with antibiotics are necessary and could conserve the uterus for future fertility.

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“…Leiomyomata are a common benign smooth muscle neoplasm in women, occurring in 20-30% of premenopausal women [ 1 ]. The cumulative incidence is approximately 70% in Caucasian women and may be as high as 80% in Afro-Caribbean women [ 2 ]. Pyomyoma, or suppurative leiomyoma, is a rare condition that occurs with infection of a leiomyoma.…”

Section: Introductionmentioning

confidence: 99%

“…MRI has not been shown to be helpful in diagnosis. The differential diagnosis includes pyometra, tuboovarian abscess, an infected ectopic pregnancy, malignancy, perforated viscus, or degenerating fibroids [ 2 , 8 ]. The most feared complication of a pyomyoma is rupture, followed by sepsis and death [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature

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Mullins

2018

Case Reports in Obstetrics and Gynecology

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Introduction Pyomyoma, or suppurative leiomyoma, is a rare complication of uterine fibroids. It occurs most commonly in the setting of pregnancy, the immediate postpartum period, or postmenopausal status. It may also arise after recent uterine instrumentation, after uterine artery embolization, or in immunocompromised patients. The most likely cause of pyomyoma is vascular compromise followed by bacterial seeding from direct, hematogenous, or lymphatic spread. Diagnosis is difficult, as the condition is rare, presents with vague symptoms, and is difficult to identify on imaging. Definitive diagnosis is only possible with surgery. Pathology shows a degenerating fibroid with hemorrhage, necrosis, cystic degeneration, and/or inflammatory change. Cultures of the pus contained within often show polymicrobial infection. Case Presentation Our patient is a 24-year-old nulligravid female who presented with a surgical abdomen, fever, hypotension, and leukocytosis. She had no significant prior medical or surgical history, no history of uterine instrumentation, and no history of pelvic infection; she was not currently sexually active at the time of presentation. She was taken to the operating room, where she underwent diagnostic laparoscopy. This showed a ruptured pyomyoma originating in the left broad ligament. She then underwent laparoscopic myomectomy. She was transferred to the ICU intubated; she slowly recovered on IV antibiotics and was discharged home on postoperative day 10. Discussion Pyomyoma is a rare condition and is even rarer in premenopausal patients without recent history of pregnancy or uterine instrumentation. This demonstrates an unusual case of spontaneous pyomyoma in the absence of risk factors, other than a history of known fibroids. Pyomyoma should be considered as a diagnosis in patients with sepsis, history of fibroids, and no other identifiable source of infection.

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Pyomyoma as a Rare Source of Postpartum Sepsis

Cited by 11 publications

References 3 publications

Spontaneous expulsion of a huge cervical leiomyoma from the vagina after cesarean

Spontaneous expulsion of a huge cervical leiomyoma from the vagina after cesarean

Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids

Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature

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