Pyometra: causes, symptoms, diagnosis, treatment

The piometer is the accumulation of pus in the uterus as a result of infection of the contents of the uterine cavity with pyogenic microorganisms when the outflow from the cavity is disturbed.

Causes of pyometers

Pathogens are associations of microorganisms with a predominance of "intrinsic" opportunistic flora, in particular obligate anaerobic microorganisms. There is a decrease in immune factors of body protection.

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

A piometer may also be one of the symptoms of endometrial cancer.

Symptoms of pyometra

Classical symptoms of pyometers - the presence of cramping pains in the lower abdomen, accompanied by the appearance of sometimes abundant purulent discharge and symptoms of purulent intoxication (fever, chills, a sense of weakness, "weakness").

However, at the present time, especially in the old age, there is often a worn out course of the disease. As a rule, there is a subfebrile condition, periodically - purulent discharge from the genital tract, in which patients often turn to the doctor. Sometimes there is an asymptomatic course of the process, when the pyometra is a finding with ultrasound.

As mentioned above, a pyometra can be one of the cardinal signs of endometrial cancer. Specific for the cancer of the body of the uterus syndrome - the presence of cramping pains in the lower abdomen, giving to the lower limbs. The admixture of blood in pus also often indicates the presence of a tumor process and the decay of a tumor.

Diagnostics of pyometers

When examined, as a rule, there are age-related trophic changes: atrophy of the vaginal mucosa, cervix, the latter is sharply truncated or smoothed; the external opening of the cervical canal is difficult to visualize. The nature of the discharge from the cervical canal can be different - from scanty pus-like secretions (found more often) to copious, purulent, discharge may be absent. The uterus body, on the contrary, is enlarged, has a round or spherical shape, a soft consistency, sensitive on palpation. Appendages, as a rule, are not determined (age atrophy). The presence of parametrical infiltrates indicates a neglected oncological process.

Hysteroscopy

For senile pyometers, characteristic hysteroscopic features are:

• atresia of the external opening or the entire cervical canal;
• expansion of the uterine cavity;
• presence in the cavity of the purulent discharge;
• age atrophy of the endometrium;
• absence of pathological inclusions.

For endometrial cancer, characteristic hysteroscopic features are:

• expansion of the uterine cavity;
• presence in the cavity of the purulent discharge;
• presence in the uterine cavity on the background of general atrophy of the endometrium of focal pathological changes (cartilaginous density of crumbly "plus tissue" or ulcerated defects - "minus tissue").

Conducting a targeted endometrial biopsy with hysteroscopy allows you to refine the diagnosis.

Treatment of pyometers

In cases of senile piometers, hysteroscopy along with sanation of the uterine cavity in addition to the diagnostic is an excellent therapeutic method. As with any purulent process, adequate antibiotic therapy is prescribed, followed by treatment with nonsteroidal anti-inflammatory drugs. Showing the appointment of antispasmodics, sanitation of the vagina.

With the confirmation of endometrial cancer - treatment in a specialized institution.

Patients are recommended periodic examinations with ultrasound control every six months.

Prevention

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