Pyocele Retrouterina

PYOCELE RETROUTERINA, periuterine suppuration resulting from pelveoperitonitis or infection of a retro-uterine hematoma (haematocele retrouterina suppurativa; see Pregnancy, extrauterine pregnancy). Infection into the hematoma may come from the intestine, through the tube from the uterus, and by the hematogenous route. R. g. represents a cystic tumor with purulent or ichorous content; its walls consist of fibrin, partially transformed into connective tissue. This tumor is usually located in the posterior Douglas, flattening and sometimes bulging the posterior fornix, having a testy consistency, sometimes fluctuating. The vaginal mucosa above the tumor is mobile. Due to adhesions with the omentum and intestines, the mobility of the tumor may be limited and its contours difficult to determine. Patients feel a sense of heaviness in the lower abdomen and pain, complain of constipation, urinary disturbances, headache, and chills. Subfebrile temperature and corresponding pulse acceleration are noted. The course of the disease is prolonged; spontaneous opening of the abscess into the rectum or bladder is possible. Diagnosis is based on a detailed history. During vaginal examination, differentiation should be made from ovarian and tube tumors and retro-uterine inflammatory exudate, as well as from a retroflexed (pregnant) uterus. Recognition is possible by puncture of the posterior fornix. The prognosis is favorable with timely recognition and treatment. Prolonged febrile condition can exhaust the patient, rupture of pus into the bladder threatens with pyelitis, rupture into the rectum sometimes gives rise to a persistent intestinal fistula. Treatment is surgical; posterior colpotomy with drainage; subsequently, resorption treatment.