Pyometra

Specialty: Gynecology and breast.

• Accumulation of pus in the uterus
• purulent uterus
• retained uterine infection

Why it occurs

• Benign or neoplastic mechanical cervical obstruction (carcinoma of the cervix, endometrium or vagina) associated with ascending bacterial infection by anaerobic and gram-negative germs
• Chronic senile endometritis in elderly patients with severe cervical atrophy
• Previous pelvic radiotherapy that induces endocervical canal stenosis
• Prolonged retention of necrotic remains post-curettage or post-partum

Initial workup

Transvaginal or transabdominal pelvic ultrasound that reveals distension of the uterine cavity occupied by anechoic/hypoechoic contents with mobile echoes and fluid-gas levels compatible with pus. Gentle diagnostic hysterometry to dilate the cervix and immediately drain the purulent secretion, taking samples for common bacterial and anaerobic microbiological culture. CT of the pelvis to assess whether there is extrauterine extension or underlying obstructive neoplasia.

Standard management

• Amoxicillin/clavulanic acid 1000/200 mg intravenously every 8 hours associated with Gentamicin 3-5 mg/kg/day intravenously, or Clindamycin 900 mg intravenously every 8 hours associated with Ceftriaxone 2 g intravenously per day. The fundamental pillar of treatment consists of dilation of the cervix and complete drainage of the pyometra in the operating room or consultation (note: it is mandatory to perform a subsequent endometrial and cervical biopsy once the acute infectious process has resolved to rule out malignancy as the primary cause of the obstruction).