Haematometra and pyometra

Definition

• Pyometra is a collection of pus in the uterine cavity resulting from impaired outflow through the cervix.
• Haematometra and haematocolpos denote the accumulation of menstrual blood in the uterus or vagina.

Occurrence & epidemiology

Epidemiology

• Pyometra is uncommon and occurs mainly in postmenopausal women; it is rare before the menopause.
• Spontaneous perforation with generalised peritonitis is extremely uncommon.

Aetiopathogenesis

Aetiology

• The most common cause is genital tract malignancy, accounting for about 35% of cases; other causes include endometrial lesions, fibroids, senile cervicitis, puerperal infection and congenital cervical anomalies.
• Further causes are cervical polyps, infection and occlusion of the cervical canal.
• In a literature review of perforated pyometra, mixed aerobic and anaerobic infection was found in most patients.
• Haematocolpos or haematometra can result from a congenital imperforate hymen, in which the hymen does not rupture spontaneously during neonatal development.

Clinical features

• Classic symptoms are purulent discharge, postmenopausal bleeding and lower abdominal pain, but none is specific; more than half of non-perforated cases are asymptomatic.
• Spontaneously perforated pyometra is difficult to diagnose clinically and commonly mimics gastrointestinal disease, so misdiagnoses are common.

Diagnosis

• Ultrasound is the first and most sensitive examination for pyometra but has a limited role once perforation has occurred; CT of the abdomen and MRI of the pelvis are additional options.

Keep learning in the app

Further reading (selection)

1. Postmenopausal spontaneous rupture of pyometra: A case report (Medicine (Baltimore) 2018, PubMed Central)
2. Spontaneous Perforation of Pyometra (Infect Dis Obstet Gynecol 2006, PubMed Central)
3. StatPearls: Imperforate Hymen (NCBI Bookshelf)

Cross-references