An unusual case of Acute Abdomen- Pyometra

22 Dec, 2022

An unusual case of Acute Abdomen- Pyometra

A middle-aged woman was rushed to the emergency department with constant severe suprapubic abdominal pain, fevers, and myalgia. Survey of medical reports revealed an endometrial biopsy six days prior to presentation. Further investigations revealed severe diffuse abdominal tenderness and guarding. After a series of unsuccessful surgeries, the reports of a total abdominal hysterectomy revealed a pyometra. This is supposedly the first case of this uncommon condition reported.

Pyometra is a rare type of intrauterine infection, and characterized by the accumulation of pus within the uterine cavity, with an incidence on 0.01-0.5% of female patients. Case studies by several health institutes suggest that it is a serious, life-threatening infection within the uterus caused by anaerobic bacterial growth within a poorly draining uterus. Although popular within the veterinary community due to frequency in dogs and cattle, is extremely infrequent in human beings.

Common Causes of Pyometra

Endometrial carcinoma Genital tuberculosis
Cervical carcinoma Cervical occlusion after surgery (prolapse surgery, endometrial ablation)
Obstetrical puerperal sepsis Radiation effect for uterine carcinoma
Senile endometritis Congenital cervix anomalies
Senile cervicitis Secondary to intrauterine infection
Submucous fibroid polyp Forgotten intrauterine device
Leiomyoma Actinomycotic pyometra- complication of forgotten intrauterine device


Though a rare condition, the incidence of associated malignancies with pyometra is considerable.

Signs and Symptoms

Pyometra often does not cause any symptom and can be found during an ultrasonography of pelvis. However, some symptoms include:

  • • Purulent vaginal discharge with traces of blood
  • • Postmenopausal bleeding
  • • Lower abdominal pain
  • • Symmetrical enlargement of the uterus
  • • Nausea and vomiting
  • • Diarrhea
  • • Pyrexia

Diagnosis of pyometra is usually difficult because it is often asymptomatic. Transvaginal ultrasound scanning is the mainstay of diagnosis but sometimes CT and MRI can be used.

What are the various treatment options?


  • Primary treatment
  • • Dilation of cervix and drainage
  • • Evidence of invasive infection- antibiotics, ATT if tubercular
  • • Regular monitoring to detect recurrent or persistent disease

  • Secondary treatment
  • • Senile endometritis
  • • Panhysterectomy
  • • Not fit for surgery- cyclic estrogen therapy

  • Secondary treatment
  • • Malignancy
  • • Treat accordingly

Pyometra can be potentially lethal hence considered as an abscess and treated promptly by dilation of the cervix, evacuation and continued drainage of the uterine cavity. Gentle curettage of the cavity and the endocervical canal after dilatation is essential to rule out associated malignant disease as well as debride the necrotic tissue. Antibiotics effective against aerobic and anaerobic bacteria should be given to all patients with evidence of invasive infection. Once docs have a control on the infection, the underlying problem can be treated with regular monitoring to detect recurrent or persistent disease. As a secondary line of treatment, Radiotherapy and Hysterectomy is often recommended to patients with senile endometritis.

Things to remember:

  • • Patients needs to be encouraged to utilize cervical screening programmes
  • • Early diagnosis and prompt treatment followed by radiotherapy is ideal management of choice for such patients

Pyometra occurs predominantly in elderly postmenopausal women. The clinical significance of this infrequent condition needs much deeper research. Until now many clinicians were misled by the diagnosis, but the latest research on the above disease is very promising in terms of better prognosis, as well as better quality of life for the patient. Unravel the management of many such gynecological emergencies by joining our course on Advanced ART with Medline Academics!

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