Pyometra

PYOMETRA (from Greek pyon- pus and metra- uterus), accumulation of pus in the uterus. Most often it forms as a result of closure of the cervical canal by cancerous growths. Pyogenic or putrefactive bacteria, found in abundance in cancerous decay, entering the closed uterine cavity, cause suppuration within it. Sometimes the formation of P. is preceded by a stage of hydrometra (see) or mucometra; P. develops secondarily in such cases. P. can also develop on the basis of traumatic atresia of the cervical canal: for example, after improperly performed amputation of the cervix with subsequent scar narrowing or obliteration of the canal, or as a result of scarring after ruptures of the cervix or necrosis of the latter during childbirth. In the latter cases, P. usually develops secondarily from lochiometra (see). In old age, atresia of the cervical canal is sometimes observed on the basis of atrophy and desquamation of the mucous membrane, and in these cases, secretions retained in the uterine cavity may be a favorable soil for the development of suppuration. Atresia of the external uterine os with formation of P. may occur in cases of uterine and vaginal prolapse, which are often accompanied by significant bedsores in the area of the external uterine os with subsequent adhesion of the latter. Similarly, P. can form with excessive elongation of the cervix. P. can also arise on the basis of cauterization of the cervix with various chemical substances (e.g., a strong solution of zinc chloride) and certain physical agents (such as pacelen, vaporization, electrolysis). Finally, P. can develop as a result of operations performed [e.g., after the Peter-Müller operation for uterine and vaginal prolapse - removal of the vagina and cervix with preservation of the uterine body]. P. can even be observed in newborn girls. Thus, Brindeau and Aburel (1928) described two cases (in breech presentations), which ended in death (in one case the vagina, uterus, and tubes were distended with pus, in the other peritonitis was observed). The amount of pus in P. can range from a few cm³ to enormous sizes. Bondarev described a case of P. that developed from lochiometra, where the pus-distended uterus represented a tumor that filled almost the entire abdominal cavity. Depending on the amount of pus, the walls of the uterus may be little changed or, conversely, thinned to extreme limits. The passage of pus into the tubes is usually not observed in P. Sometimes an adhesive perimetritic process is observed. The mucous membrane of the uterus in P. contains a huge number of plasma cells, sometimes an admixture of giant cells. Infiltrates can penetrate deeply into the uterine muscle. The accumulation of pus in the uterine cavity is sometimes discovered only accidentally during an operation undertaken for the underlying disease. In some cases, P. is accompanied by typical purulent fever with all its characteristic phenomena and pains in the lower abdomen. Treatment of P. in most cases comes down to complete extirpation of the uterus, which often coincides with the treatment of the underlying disease. In certain cases, however, it is more rational to establish stable patency of the cervical canal, drainage, and systematic irrigation of the purulent cavity. Among the rare forms of P. are P. lateralis and pyoelytrometra lateralis. P. lateralis forms as a result of suppuration in one of the cavities of a double uterus, if there is atresia of the cervical canal of one of the halves of the improperly developed uterus. Most often, suppuration occurs after spontaneous rupture into the vagina of the contents of haematometra lateralis. Pyoelytrometra lateralis forms as a result of suppuration in the cavity of haematoelytrometra lateralis, with infection penetrating through the opening that forms as a result of spontaneous rupture of the rudimentary blind vaginal pouch corresponding to one of the halves of the double uterus. Cases of P. on the basis of suppuration of the haematometra cavity (see) are no less rare. After the discharge of the purulent and usually foul-smelling contents of pyoelytrometra lat. or P. lat., the perforation opening may close, and pus again accumulates in the pouch, only to later rupture again into the vagina under the influence of increased pressure. If the opening remains open, then the discharge of very foul-smelling pus becomes constant. Differential diagnosis between pyoelytrometra lat. and P. lateralis, on the one hand, and purulent para- or perimetritis or suppuration of an ovarian cyst with rupture of the abscess into the vagina, on the other, is very difficult. Great assistance is provided by anamnestic data and indications that suppuration was preceded by a sudden significant discharge from the vagina of thick bloody fluid, characteristic of haematometra. Treatment consists in sufficient dilatation of the atretic cervical canal or opening into the rudimentary vaginal pouch, followed by repeated irrigation of the cavity with disinfectant solutions. E. Shvartsman.