ПИОМЕТРА КАО ПОСЛЕДИЦА 40-ГОДИШЊЕГ НОШЕЊА ИНТРАУТЕРУСНОГ УЛОШКА И ХРОНИЧНОГ ЕНДОМЕТРИТИСА

Abstract

Pyometra is the accumulation of pus in the uterine cavity, thus streaching its walls and thinning and enlarging the uterus. This change is characteristic of the senium period of life, when the uterus is atrophic with a stenotic cervical canal. It most frequently occurs as a result of secondary infection of the cancerogenic tissue of the uterus and additional stenosation and clogging up of cervical canal by a malignant proces. Apart from carcinomas of the body and uterus cervix, pyometra less often can occur in other illnesses such as senile endometritis and senile colpitis. As pyometra most frequently occurs in uterine carcinomas, in detection of this state, we must think of malignancy and direct our examination to this direction. In this paper we present a patient in whom pyometra developed because she carried an intrauterine device for forty years that resulted in chronic endometritis. The main simptoms for which the patient was admited to hospital were abdominal pain and intensive suppurative vaginal excretion a month after removal of intrauterine device. The diagnosis of pyometra was made by gynaecological and ultrasound examinations, and also on the basis of gynaecological and ultrasound examinations one month after chronic endometritis was confirmed. On the basis of this finding we suspected that chronic endometritis was caused by this state. By cytological, PAP and histopathological axaminations of samples obtained by explorative curettage and biopsy of the uterine cervix, malignant changes were eliminated a posible cause. By laboratory analysis and bacteriological examination of the uterine cavity and vaginal excretion, inflamatory changes of the uterine mocous membrane were confirmed as a cause of the pyometra. This conditions was due to carrying the intrauterine device for more decades. The therapy consisted of dilatation of the cervical canal and evacuation of accumulated suppurative contents and irrigation of uterine cavity with 3% sollution of hydrogen peroxide and Povidon. Also wide spectrum antibiotics and uterotonics were given. Such treatment contributed to a fast and effectious recovery.

Keywords: pyometra, intrauterine device, chronic endometritis