Pyometra: causes, symptoms, diagnosis, treatment

Pyometra is an accumulation of pus in the uterus as a result of infection of the contents of the uterine cavity with pyogenic microorganisms due to a disruption of the outflow from its cavity.

Causes of pyometra

Pathogens are associations of microorganisms with a predominance of their own opportunistic flora, in particular obligate anaerobic microorganisms. A decrease in the body's immune defense factors is noted.

Provoking factors: atresia or obliteration of the cervical canal as a result of age-related atrophic changes. Therefore, the so-called "senile" pyometra is more often observed.

Pyometra can also be one of the symptoms of endometrial cancer.

Symptoms of Pyometra

Classic symptoms of pyometra are the presence of cramping pains in the lower abdomen, accompanied by the appearance of sometimes quite abundant purulent discharge and symptoms of purulent intoxication (fever, chills, feeling of weakness, “being broken”).

However, at present, especially in old age, the latent course of the disease is more common. As a rule, there is subfebrile temperature, periodically - purulent discharge from the genital tract, about which patients most often consult a doctor. Sometimes there is an asymptomatic course of the process, when pyometra is a finding during ultrasound.

As mentioned above, pyometra can be one of the cardinal signs of endometrial cancer. A syndrome specific to uterine cancer is the presence of cramping pains in the lower abdomen, radiating to the lower extremities. Blood in the pus also often indicates the presence of a tumor process and tumor decay.

Diagnosis of pyometra

During examination, age-related trophic changes are usually present: atrophy of the vaginal mucosa, cervix, the latter is sharply shortened or smoothed; the external opening of the cervical canal is visualized with difficulty. The nature of the discharge from the cervical canal may vary - from scanty purulent discharge (more common) to abundant, purulent, discharge may be absent. The body of the uterus, on the contrary, is enlarged, has a round or spherical shape, soft consistency, sensitive to palpation. The appendages, as a rule, are not determined (age-related atrophy). The presence of parametric infiltrates indicates an advanced oncological process.

Hysteroscopy

For senile pyometra, the characteristic hysteroscopic signs are:

• atresia of the external opening or the entire cervical canal;
• dilation of the uterine cavity;
• the presence of purulent discharge in the cavity;
• age-related endometrial atrophy;
• absence of pathological inclusions.

For endometrial cancer, characteristic hysteroscopic signs are:

• dilation of the uterine cavity;
• the presence of purulent discharge in the cavity;
• the presence in the uterine cavity against the background of general endometrial atrophy of focal pathological changes (cartilaginous density of crumbly “plus tissue” or ulcerated defects - “minus tissue”).

Performing a targeted endometrial biopsy during hysteroscopy allows for a more precise diagnosis.

Treatment of pyometra

In cases of senile pyometra, hysteroscopy together with sanitization of the uterine cavity in addition to diagnostic is an excellent treatment method. As with any purulent process, adequate antibacterial therapy is prescribed, then treatment with non-steroidal anti-inflammatory drugs. The appointment of antispasmodics, vaginal sanitization are indicated.

If endometrial cancer is confirmed, treatment is provided in a specialized institution.

Patients are recommended to undergo periodic examinations with ultrasound monitoring every six months.

Prevention

Timely administration of hormone replacement therapy, prevention and early diagnosis of endometrial cancer.