1
|
Busshoff J, Thangarajah F, Morgenstern B. Uterus-preserving management of pyomyoma: Case report of a rare complication after uterine artery embolization. Case Rep Womens Health 2022; 34:e00405. [PMID: 35356268 PMCID: PMC8958551 DOI: 10.1016/j.crwh.2022.e00405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Pyomyoma of the uterus is a rare but severe complication of uterine artery embolization (UAE). This report describes the uterus-preserving management of a case of fast-developing pyomyoma. Screening methods to minimize the risk of this condition are discussed. Case A 46-year-old woman presented with fever, abdominal pain and blood stream infection on the third day after UAE, which had been performed to treat symptomatic uterine myomatosus. Broad-spectrum antibiotics proved inadequate. Magnetic resonance imaging (MRI) showed a possible superinfection of the necrotic myoma. Vaginal smear showed the same organism, a resistant Escherichia coli, as in the blood culture. Because the patient declined hysterectomy, multiple hysteroscopies with removal of necrotic pyomyoma were performed. In addition, an intrauterine gentamicin chain was placed. To our knowledge, this is the first case of pyomyoma immediately after UAE and the first report of successful hysteroscopic treatment in a septic patient. Conclusion In order to reduce the risk of pyomyoma, pre- and postinterventional algorithms should be used. Initial symptoms of pyomyoma can easily be confounded with post embolization syndrome after UAE. Localized gas collection of a necrotic myoma combined with signs of infection can be an indication for pyomyoma. Hysteroscopical resection is an alternative to abdominal surgery e.g. in case of high operative risk/wish of childbreading. Patients with germ detection in vaginal smear should be considered high risk patients for developing a pyomyoma after UAE.
Collapse
Affiliation(s)
- Jana Busshoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Gynecology and Obstetrics, Germany
| | - Fabinshy Thangarajah
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Gynecology and Obstetrics, Germany
| | - Bernd Morgenstern
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Gynecology and Obstetrics, Germany
| |
Collapse
|
2
|
Ogbu UG, Alao AI, Akunaeziri UA, Chido-Abba R. Pyomyoma in a primigravida at term: a case report. Pan Afr Med J 2022; 41:180. [PMID: 35573436 PMCID: PMC9074050 DOI: 10.11604/pamj.2022.41.180.33913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 11/11/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Uchechukwu George Ogbu
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Keffi, Nasarawa State, Nigeria
- Westcare Hospital, Ejigbo, Lagos State, Nigeria
| | - Abayomi Ibukun Alao
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Keffi, Nasarawa State, Nigeria
| | | | | |
Collapse
|
3
|
Oshina K, Ozaki R, Kumakiri J, Murakami K, Kawasaki Y, Kitade M, Itakura A. Pyomyoma mimicking tubo-ovarian abscess: Two case reports. Case Rep Womens Health 2021; 33:e00372. [PMID: 34900612 PMCID: PMC8637316 DOI: 10.1016/j.crwh.2021.e00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Pyomyoma is an extremely rare complication, defined as an infection of a uterine leiomyoma. We describe two cases of pyomyoma that were initially considered to be tubo-ovarian abscesses but were later diagnosed as pyomyomas and managed with laparoscopic surgery. Case 1 was a 26-year-old nulliparous woman who was previously diagnosed with bilateral endometriomas and presented to the hospital with lower abdominal pain. Magnetic resonance imaging revealed bilateral endometrial cysts and a 4-cm mass consistent with a tubo-ovarian abscess. The patient experienced continuous pain, and the cyst in the left adnexa enlarged; thus, laparoscopic surgery was performed. The cystic tumor in her uterus contained purulent fluid. Therefore, an abscess in the degenerative subserous myoma was diagnosed. Case 2 was a 47-year-old nulliparous woman who had undergone total mastectomy and postoperative radiotherapy for breast cancer. She was undergoing hormone therapy when she presented to the hospital with lower abdominal pain, fever, and increased inflammatory markers. Computed tomography revealed a 7-cm tumor with rim enhancement in her left adnexa; therefore, a tubo-ovarian abscess was suspected. After admission, drainage was performed under transvaginal ultrasound guidance, and antibiotics were administered. However, these treatments did not relieve her abdominal pain. Emergency laparoscopic surgery was performed, and intraoperative findings demonstrated an abscess in the degenerative subserous myoma of the uterus with normal adnexa. Laparoscopic hysterectomy and bilateral salpingectomy were performed. Laparoscopic surgery was effective for both patients. Delayed diagnosis of pyomyoma can result in serious complications. Timely surgery with concomitant antibiotic treatment may facilitate good outcomes. Pyomyoma is extremely rare and can be difficult to diagnose. Symptoms of pyomyoma are similar to those of other reproductive conditions. Pymyoma may occur in young women. Surgery, in addition to antibiotic treatment, should be considered for pyomyoma.
Collapse
Affiliation(s)
- Kyoko Oshina
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Rie Ozaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Jun Kumakiri
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Keisuke Murakami
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yu Kawasaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| |
Collapse
|
4
|
Peris H, Del Riego J, Criado E, García-Chamón RB, Vall E, Mayoral M, Martín A. Value of diffusion-weighted magnetic resonance imaging in the diagnosis of pyomyoma. Radiol Case Rep 2021; 17:137-141. [PMID: 34820037 PMCID: PMC8601966 DOI: 10.1016/j.radcr.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Pyomyomas are rare lesions that develop from the suppurative degeneration of ischemic leiomyomas. Pyomyomas can lead to sepsis, so early diagnosis is crucial. Due to their rarity and often nonspecific findings on ultrasonography and computed tomography diagnosis is often delayed. We present a case of a woman who presented with abdominal pain and fever. The computed tomography showed a large hypodense uterine lesion with slight peripheral enhancement without gas in the lesion. The diffusion-weighted magnetic resonance imaging showed restricted diffusion, demonstrating the presence of pus and confirming the diagnosis of pyomyoma. Diffusion-weighted imaging should be done in cases of suspected pyomyomas when computed tomography findings are nonspecific.
Collapse
Affiliation(s)
- Helena Peris
- Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, Sabadell, Barcelona 08208, Spain
| | - Javier Del Riego
- Women's Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Eva Criado
- Interventional Radiology, Department of Radiology, UDIAT Centre Diagnòstic. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Rosa Belén García-Chamón
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Elisenda Vall
- Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, Sabadell, Barcelona 08208, Spain
| | - María Mayoral
- Diagnostic Imaging Center, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Barcelona, Spain
| | - Amaya Martín
- Women's Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| |
Collapse
|
5
|
Wang J, Li Z, Sun Y. Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids. BMC Pregnancy Childbirth 2021; 21:132. [PMID: 33579230 PMCID: PMC7881529 DOI: 10.1186/s12884-021-03619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pyomyoma is an unusual fibroid that usually develops during the puerperal or postmenopausal period. If not promptly diagnosed and treated, it can become life threatening. Although various conservative and surgical therapies have been discussed in the literature for this condition, there are very few reports related to the management of prolapsed pedunculated submucosal myoma. Case presentation In this case report, an intramural fibroid transformed into a pedunculated submucosal pyomyoma, which prolapsed into the vagina after a miscarriage and caused life-threatening toxic shock. Apart from prompt antibiotic treatment, a transabdominal myomectomy rather than hysterectomy was performed due to the very large diameter of the pyomyoma. As a result, fertility was preserved, and the patient conceived naturally and delivered a healthy baby two years later. Discussion and conclusions It is important to maintain strong clinical suspicion for pregnant or postpartum women with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma. Timely recognition and prompt surgical treatment with antibiotics are necessary and could conserve the uterus for future fertility.
Collapse
Affiliation(s)
- Jingxue Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, 100034, Beijing, P.R. China
| | - Zheng Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, 100034, Beijing, P.R. China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Peking University First Hospital, 100034, Beijing, P.R. China.
| |
Collapse
|
6
|
Wasinghon P, Huang KG, Lai SY. Total Laparoscopic Hysterectomy of an Endocervical Pyomyoma Over Previous Cesarean Section Wound. Gynecol Minim Invasive Ther 2020; 9:101-103. [PMID: 32676290 PMCID: PMC7354753 DOI: 10.4103/gmit.gmit_103_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 09/20/2019] [Accepted: 03/18/2020] [Indexed: 11/06/2022] Open
Abstract
A 41-year-old female, G2P2, who experienced menorrhagia for 1 month, had had a history of myoma uteri for the previous 5 years. The computed tomography showed a leiomyoma mass of approximately 8 cm. She underwent a total laparoscopic hysterectomy with bilateral salpingectomy. This pyomyoma originated in the endocervix over the cesarean section wound. The postoperative care was uneventful. Pyomyoma is a rare condition and is even rarer in premenopausal patients without a history of pregnancy or uterine instrumentation. The spontaneous pyomyoma at the endocervical leiomyoma demonstrated an unusual case in the absence of risk factors. Pyomyoma could be considered as a diagnosis in patients without fever, history of fibroids, and no other identifiable sources of infection.
Collapse
Affiliation(s)
- Phornsawan Wasinghon
- Department of Obstetrics and Gynecology, Buddhachinnaraj Hospital, Phitsanulok, Thailand.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Yen Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan
| |
Collapse
|
7
|
Ezzedine D, Ndubizu C, Kayani S, David A. Pyomyoma after uterine artery embolization: A case report. Case Rep Womens Health 2020; 26:e00186. [PMID: 32181148 PMCID: PMC7063122 DOI: 10.1016/j.crwh.2020.e00186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background Uterine pyomyoma is a rare complication of uterine artery embolization (UAE), and causes significant morbidity and mortality. This report describes the diagnosis and prompt management of this condition. Case A 48-year-old woman presented with fever, chills, and diffuse abdominal pain 15 days after undergoing UAE for symptomatic fibroids. Computed tomography showed the uterus to be significantly distended, with multiple intra-cavitary masses containing a large amount of gas and air–fluid level. Sepsis secondary to post-UAE pyomyoma was suspected. Hemodynamic resuscitation and broad-spectrum antibiotics were immediately started. The patient underwent emergency exploratory laparotomy with total hysterectomy. Conclusion In order to ensure appropriate and timely intervention, the diagnosis of uterine pyomyoma should be considered in patients presenting with signs of infection and abdominal pain after UAE. Uterine pyomyoma is a potentially life-threatening complication of uterine artery embolization. It is important to have a high index of suspicion among first line providers for uterine pyomyoma when patients present with the triad of fever, leiomyoma, and no other source for infection. A timely management of pyomoyma consists of appropriate resuscitation and antibiotics in addition to surgery when clinically warranted.
Collapse
Affiliation(s)
- Dima Ezzedine
- Obstetrics and Gynecology Department, Maimsonides Medical Center, Brooklyn, NY 11219, United States of America
| | - Chima Ndubizu
- Obstetrics and Gynecology Department, Maimsonides Medical Center, Brooklyn, NY 11219, United States of America
| | - Sohaib Kayani
- Obstetrics and Gynecology Department, Maimsonides Medical Center, Brooklyn, NY 11219, United States of America
| | - Allison David
- Obstetrics and Gynecology Department, Maimsonides Medical Center, Brooklyn, NY 11219, United States of America
| |
Collapse
|
8
|
Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2018; 2018:1026287. [PMID: 30057837 PMCID: PMC6051118 DOI: 10.1155/2018/1026287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Pyomyoma, or suppurative leiomyoma, is a rare complication of uterine fibroids. It occurs most commonly in the setting of pregnancy, the immediate postpartum period, or postmenopausal status. It may also arise after recent uterine instrumentation, after uterine artery embolization, or in immunocompromised patients. The most likely cause of pyomyoma is vascular compromise followed by bacterial seeding from direct, hematogenous, or lymphatic spread. Diagnosis is difficult, as the condition is rare, presents with vague symptoms, and is difficult to identify on imaging. Definitive diagnosis is only possible with surgery. Pathology shows a degenerating fibroid with hemorrhage, necrosis, cystic degeneration, and/or inflammatory change. Cultures of the pus contained within often show polymicrobial infection. Case Presentation Our patient is a 24-year-old nulligravid female who presented with a surgical abdomen, fever, hypotension, and leukocytosis. She had no significant prior medical or surgical history, no history of uterine instrumentation, and no history of pelvic infection; she was not currently sexually active at the time of presentation. She was taken to the operating room, where she underwent diagnostic laparoscopy. This showed a ruptured pyomyoma originating in the left broad ligament. She then underwent laparoscopic myomectomy. She was transferred to the ICU intubated; she slowly recovered on IV antibiotics and was discharged home on postoperative day 10. Discussion Pyomyoma is a rare condition and is even rarer in premenopausal patients without recent history of pregnancy or uterine instrumentation. This demonstrates an unusual case of spontaneous pyomyoma in the absence of risk factors, other than a history of known fibroids. Pyomyoma should be considered as a diagnosis in patients with sepsis, history of fibroids, and no other identifiable source of infection.
Collapse
|
9
|
Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res 2017; 43:1789-1804. [PMID: 28892210 DOI: 10.1111/jog.13437] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 02/02/2023]
Abstract
AIM Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. METHODS Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. RESULTS Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. CONCLUSIONS Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.
Collapse
Affiliation(s)
- Giusi Natalia Milazzo
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Angelica Catalano
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Valentina Badia
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Maddalena Mallozzi
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| |
Collapse
|