A woman presenting with postabortal pyomyoma and treated with exploratory laparotomy with myomectomy and fistulectomy: a case report

Abstract

Pyomyoma (suppurative leiomyoma of the uterus) is a rare condition resulting from infarction and infection of a leiomyoma. It is more usual in pregnant women or postmenopausal women who have vascular disease. The condition is usually fatal unless treated with appropriate antibiotics and surgical intervention. We report a case of a 42-year-old woman who presented with abdominal pain and lump abdomen for 6 months with fever over a period of one month with anaemia for which she was readmitted. She had a history of incomplete abortion with fibroid with red degeneration for which check evacuation was done one and half months before readmission. During the course of treatment in hospital she developed an umbilical fistula with continuous drainage of pus. Her clinical presentation proved to be a diagnostic dilemma mimicking other clinical entities including Tuberculosis and ovarian cancer. Her blood culture and urine culture were sterile. She was widal (dilution) positive and Mantoux negative. Her pus culture from umbilical wound and vaginal swab culture revealed growth of E- coli sensitive to gentamicin and amoxicillin clavulanic acid. An ultrasound scan suggested uterine fibroid with mixed echogenic collection in pelvic cavity with fistulous communication to the umbilicus, but a Magnetic resonance imaging scan suggested a big mass that appeared heterogeneous with fluid filled areas in posterior wall. She was treated with several courses of antibiotics and finally had to undergo laparotomy. During laparotomy, it was found that a large pyomyoma came into view which was successfully removed followed by fistulectomy by surgeon. The patient had uneventful recovery till discharge from hospital. The diagnosis of pyomyoma should be considered in perimenopausal women with large fibroids and pyrexia of unknown origin.