J Korean Geriatr Soc.  2016 Mar;20(1):42-48. 10.4235/jkgs.2016.20.1.42.

Pyometra in Elderly Patients and Its Clinical Characteristics

• Cho IA
• Park JE
• Baek JC

• KMID: 2161209
• DOI: http://doi.org/10.4235/jkgs.2016.20.1.42

Abstract

BACKGROUND
Pyometra should be treated with caution in elderly patients because it may indicate a malignancy in the post-menopausal period and can result in life-threatening complications such as septicemia or pan-peritonitis.
METHODS
We retrospectively analyzed the clinical features of 30 patients aged ≥65 years who received treatment for pyometra between January 2010 and December 2014.
RESULTS
The 30 patients (age: median, 74 years; range, 66-88 years) were evaluated. They presented with vaginal discharge (n=17), vaginal bleeding (n=8), abdominal pain (n=6), or fever (n=3). The most common accompanying systemic disease was hypertension (n=15), followed by diabetes mellitus (n=10). Of the 30 cases, seven were associ- ated with gynecologic malignancy (cervical cancers, n=3; endometrial cancers, n=3; and ovarian cancer, n=1); and 14, with gynecologic benign diseases (uterine myoma, n=5; cervical intraepithelial neoplasia, n=4; tubo-ovarian abscess, n=3; endometrial polyp, n=1; uterine prolapse, n=1). All the patients were treated with cervical dilatation and drainage. Fifteen patients underwent gynecologic surgery with antibiotic therapy, and 15 received empirical antibiotic treatment alone. Two women experienced spontaneous perforation of pyometra. Pyometra is considered a complication of benign and malignant gynecologic disease, until proven otherwise.
CONCLUSION
In elderly patients with comorbidities, pyometra might induce severe complications such as pan-peritonitis or sepsis. Early accurate diagnosis is important to determine an appropriate individualized treatment to reduce morbidity and mortality.

Keyword

Pyometra; Malignancy; Elderly; Peritonitis

MeSH Terms

Abdominal Pain
Abscess
Aged*
Cervical Intraepithelial Neoplasia
Comorbidity
Diabetes Mellitus
Diagnosis
Drainage
Endometrial Neoplasms
Female
Fever
Genital Diseases, Female
Gynecologic Surgical Procedures
Humans
Hypertension
Labor Stage, First
Mortality
Myoma
Ovarian Neoplasms
Peritonitis
Polyps
Postmenopause
Pregnancy
Pyometra*
Retrospective Studies
Sepsis
Uterine Hemorrhage
Uterine Prolapse
Vaginal Discharge