Postmenopausal Idiopathic Spontaneous Rupture of Pyometra with Tubo-ovarian Abscess: An Atypical Presentation.

IF 1.2 Q3 OBSTETRICS & GYNECOLOGY
Journal of Mid-life Health Pub Date : 2024-04-01 Epub Date: 2024-07-05 DOI:10.4103/jmh.jmh_6_24
Nikita Krishna, Kiran Aggarwal, Prabha Lal, Anuradha Singh
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引用次数: 0

Abstract

Spontaneous perforations in pyometra occur rarely. Incidence is only 0.01%-0.5% in gynecological patients. Tubo-ovarian abscess (TOA) is seen less in postmenopausal women amounting the 6%-18% of the total cases of TOA reported. A 52-year-old P3L3 postmenopausal woman with abdominal pain was admitted to hospital. Emergency laparotomy was performed in view of pyoperitoneum. Intraoperatively, 1000 cc of foul-smelling pus was suctioned out from the peritoneal cavity a 2 cm × 2 cm sized perforation was seen at the right fundal region of the uterus and a right sided TOA was seen extending to the uterine cavity, left sided ovary was normal. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The patient got discharged on the 36th postoperative hospitalization day. Histopathological study revealed uterine purulent inflammation with no evidence of malignancy. The diagnosis of spontaneous perforation of pyometra is rarely made preoperatively and the possibility of a perforated pyometra should, therefore, be considered when elderly women suffer from acute abdominal pain. Hysterectomy and bilateral salpingo-oophorectomy may be the best choice procedure in these patients. There is probably a new trend in the epidemiology of TOA, occurring in older women who do not present the traditional risk factors for pelvic inflammatory disease and TOA.

绝经后特发性子宫脓肿自发性破裂伴输卵管卵巢脓肿:非典型表现
子宫脓肿自发性穿孔很少发生。妇科病人的发病率仅为 0.01%-0.5%。输卵管卵巢脓肿(TOA)较少见于绝经后妇女,占报告的 TOA 总病例的 6%-18%。一名 52 岁的 P3L3 绝经后妇女因腹痛入院。考虑到腹腔积液,她接受了紧急开腹手术。术中,从腹腔中吸出1000毫升恶臭的脓液,在子宫右底区域看到一个2厘米×2厘米大小的穿孔,右侧TOA延伸至子宫腔,左侧卵巢正常。患者接受了全腹子宫切除术和双侧输卵管切除术。患者于术后第36天出院。组织病理学检查显示子宫化脓性炎症,无恶性证据。术前很少能诊断出子宫脓肿自发性穿孔,因此,当老年妇女出现急性腹痛时,应考虑子宫脓肿穿孔的可能性。子宫切除术和双侧输卵管切除术可能是这些患者的最佳选择。TOA的流行病学可能出现了一种新趋势,即发生在没有盆腔炎和TOA传统危险因素的老年妇女身上。
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来源期刊
Journal of Mid-life Health
Journal of Mid-life Health Social Sciences-Health (social science)
CiteScore
1.70
自引率
9.10%
发文量
39
审稿时长
43 weeks
期刊介绍: Journal of mid-life health is the official journal of the Indian Menopause society published Quarterly in January, April, July and October. It is peer reviewed, scientific journal of mid-life health and its problems. It includes all aspects of mid-life health, preventive as well as curative. The journal publishes on subjects such as gynecology, neurology, geriatrics, psychiatry, endocrinology, urology, andrology, psychology, healthy ageing, cardiovascular health, bone health, quality of life etc. as relevant of men and women in their midlife. The Journal provides a visible platform to the researchers as well as clinicians to publish their experiences in this area thereby helping in the promotion of mid-life health leading to healthy ageing, growing need due to increasing life expectancy. The Editorial team has maintained high standards and published original research papers, case reports and review articles from the best of the best contributors both national & international, consistently so that now, it has become a great tool in the hands of menopause practitioners.
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