Collection of pus in the uterine cavity is called pyometra. The prerequisites for pyometra formation are :
Occlusion of the cervical canal.
Enough sources of pus formation inside the uterine cavity.
Presence of low grade infection.
Causes
Obstetrical—The only condition is following infection of lochiometra.
Gynecological—The conditions which are associated with pyometra are:
a) Carcinoma in the lower part of the body of uterus
b) Endocervical carcinoma
c) Senile endometritis
d) Infected hematometra following amputation, conization or deep cauterization of cervix
e) Tubercular endometritis.
Pathology: There is abundant secretion of pus from the offending sites. The cervical canal gets blocked due to senile narrowing by fibrosis or due to debris. The accumulated pus distends the uterine cavity. The postmenopausal atrophic myometrium fails to expel the collected pus. Thus, the uterus gets enlarged more and more with thinning of its wall. The lining epithelium is lost at places and replaced by granulation tissue. The organisms responsible are coliforms, streptococci or staphylococci. Rarely, it may be tubercular. Except in tubercular (caseous), the fluid is thin, offensive, at times purulent or blood stained. The pus may be sterile on culture or the offending organism can be detected.
Clinical Features: The patient complains of intermittent blood stained purulent offensive discharge per vaginam. There may be occasional pain in lower abdomen.
Systemic manifestation is usually absent.
Per abdomen: An uniform suprapubic swelling may be felt of varying size. It is cystic with well-defined margins but lower pole is not felt. It may be tender.
Internal examination reveals: The swelling is uterine in origin. The offensive discharge is seen escaping out through the cervix.
Pelvic ultrasonography reveals distended uterine cavity with accumulation of fluid within.
Diagnosis is confirmed by dilatation of the cervix when pus escapes. In every case, all types of investigations are to be made to exclude malignancy of the body of the uterus and endocervix. Diagnostic curettage should be withheld for about 7–14 days following dilatation and drainage of pus. This will minimize such complications such as perforation of the uterus and spreading peritonitis. During the interval period, antibiotics should be prescribed.
Treatment: Once malignancy is excluded, the pyometra is drained by simple dilatation of the cervix. Even in non-malignant cases or in cases of recurrence, hysterectomy may be indicated. Definite surgery for malignancy is to be done following drainage of pus.
