Pyocolpos: causes, symptoms, diagnosis, treatment

The causes of pyocolpos are a violation of the natural outflow from the vagina and infection of its contents as a result of congenital anomalies or acquired strictures.

The greatest number of diagnostic and treatment errors occurs in patients with malformations of the genital organs, in particular when the contents of the accessory closed vagina become infected.

Symptoms of Pyocolpos

Incomplete doubling of the uterus with the presence of an additional closed vagina is accompanied by a unilateral delay in menstrual blood. A characteristic sign of the disease is the presence of persistent algomenorrhea. The distinctive features of the disease are the following symptoms of pyocolpos:

• pain appears soon after menarche, is associated with menstruation, intensifies on the 3-4th day of menstruation and continues for 3-5 days after it;
• the pain is often of a spasmodic nature;
• is characterized by stable one-sided localization of pain. With prolonged existence of hematocolpos, the contents become infected, which is accompanied by a temperature reaction, increased pain, which takes on a "twitching", pulsating character.

Diagnosis of pyocolpos

When palpating the lateral and lower parts of the uterus, a fixed "tumor-like" one-sided formation is determined. A study of the urinary system helps to establish the correct diagnosis: thus, in 100% of cases of congenital vaginal defects, renal aplasia is detected on the side of the closed vagina. When puncturing the formation, a tarry or purulent fluid is obtained, containing elements of blood and leukocytes.

Differential diagnosis

This group of patients accounts for the largest number of medical errors. Typical diagnoses for which erroneous laparotomy is performed are:

• tubo-ovarian abscess;
• suppurating endometrioid cyst;
• suppurating paraovarian cyst.

Treatment of pyocolpos

The most correct treatment with timely diagnosis is conservative surgical treatment, which consists of dissecting the wall of the additional closed vagina and creating a connection between it and the functioning vagina.

To do this, an oval incision is made above the lower pole of the formation along the lateral wall of the vagina in its upper third above the protruding, usually thinned and bluish mucous membrane. In doubtful cases, the formation should be punctured and the closed vagina opened "along the needle". The incision should be large enough, and the newly formed opening should be able to easily pass a finger. After emptying the closed vagina, the latter is washed with an antiseptic solution. The edges of the opening of the vaginal mucous membrane are sutured with separate vicryl sutures, preventing its contraction.

Patients are recommended to follow an active regimen - early rising (on the first day), daily douching. All patients are subsequently recommended abdominal delivery.

In advanced cases (pyometra and pyosalpinx), as well as in the presence of organic pathology, radical treatment is carried out - laparotomy and extirpation of the uterus with a closed vagina.

Prevention of pyocolpos

Currently, there are no effective preventive measures, except for maintaining hygiene during pregnancy (excluding exposure to harmful exogenous factors, especially during the period of 6-17 weeks, when this developmental defect may develop).

Much more often, pyocolpos occurs when accumulated menstrual blood becomes infected due to malformations accompanied by a complete delay in the outflow of menstrual blood (hymenal atresia, retrohymenal septum, transverse vaginal septum, aplasia of part or all of the vagina with a functioning uterus).

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