Pyomyoma mimicking tubo-ovarian abscess: Two case reports

Spontaneous ruptured pyomyoma: A rare yet critical postpartum complication: A case report

Pyomyoma, a rare complication of leiomyoma, presents a unique clinical challenge due to its infrequency with potentially fatal complications. Herein, we report the case of a 44-year-old Para 3+1 woman with red degeneration of uterine fibroids during pregnancy, who experienced worsening abdominal pain and foul smelling vaginal discharge 1 week post Caesarean section. Despite hemodynamic stability, her septic markers were markedly raised. A bedside ultrasound noted a pelvic complex cystic collection, further confirmed on CT scan as spontaneous ruptured of pyomyoma complicated by complex fistulas with surrounding organs. She underwent total abdominal hysterectomy and abdominal washout the next day, with intravenous antibiotic on-board. Histology examination confirmed acute suppurative inflammation of the uterine fibroid with endometritis. This case report contributes to the existing medical literature by shedding light on a rare and potentially life-threatening leiomyoma complication. Its potential to mimic acute puerperal endometritis, makes its diagnosis especially challenging, necessitating a high index of suspicion.

Pyomyoma after caesarean section: a rare entity

Pyomyoma, a rare complication of a myoma undergoing infarction and subsequent infection, may be a diagnostic challenge in patients with unexplained puerperal fever. A woman in her 30s presented with fever and foul-smelling discharge per vaginum, 6 months after her first caesarean section (CS). She underwent an elective CS for symptomatic placenta praevia at 34 weeks of gestation. Intra-operatively, post-partum haemorrhage was managed with uterotonics and blood transfusions. However, 2 weeks later, she developed a high-grade fever that was non-responsive to parenteral antibiotics. She continued to have intermittent episodes of high-grade fever, which were treated on an outpatient basis. Six months later, she developed purulent vaginal discharge, which grew Escherichia coli on bacterial culture. She received intravenous antibiotics and blood. Radiology confirmed the presence of a large fibroid with a focal capsular breach and peripherally enhanced collection extending to the endometrial cavity. The patient subsequently underwent a myomectomy. Intra-operatively, a large fundal myoma with endometrial breach and purulent discharge in the fibroid and endometrial cavity was noted. She sustained the procedure well and recovered uneventfully.

Pyomyoma in a primigravida at term: a case report

Pyomyoma is a rare complication of uterine fibroid occurring most commonly in pregnancy, post-partum, post-abortion, and post-menopausal periods. It results from infarction, necrosis and secondary infection of leiomyoma. We report a case of 29-year-old primigravida with breech at term co-existing with cystic degenerative uterine fibroid, who presented with recurrent fever and abdominal pain. She had caesarean section and was found to have pyomyoma intraoperatively. She subsequently had drainage of pus, caesarean myomectomy and antibiotics therapy. She had good outcome and was discharged on fifth postoperative day. Pyomyoma should be suspected in pregnant women with leiomyoma, unexplained recurrent fever, abdominal pain and cystic degenerative changes on ultrasound.