Pyomyoma presenting as a case of acute abdomen: A case report

Abstract

Background: uterine Leiomyomata is common benign pelvic tumour in our environment. It usually presents with menstrual irregularities and pressure symptoms. Pyomyoma (suppurative leiomyoma) is a rare complication associated with degenerating leiomyoma which often results in serious complications. Though most reported cases have occurred in pregnant or postmenopausal women, we present a case of pyomyoma in a young Nigerian woman.

Case presentation: she is a 32 year old nulliparous housewife who presented with  abdominal pain and swelling of 4 months duration and fever of 2 weeks duration. She had a history of leiomyoma having done an earlier ultrasound scan. She used some Chinese herbal medications prior to the worsening of the abdominal pain and onset of fever. She also used several oral and intravenous broad spectrum antibiotics with no relief of her symptoms. Abdominal examination revealed a 28 weeks size pelvic mass, tender with differential warmth. Ultrasound scan reported features suggestive of multiple loculated pelvic abscesses with the uterus, ovaries and tubes not visualized. With the clinical impression of an acute abdomen with pelvic abscess collection and coexisting uterine fibroids, an exploratory laparotomy was done. Intra-operative findings revealed pyoperitoneum of 1.5 litres and a bulky uterus riddled with degenerating fibroids contained in intra-myometrial pus filled cavities in the uterus. The postoperative course surprisingly was uneventful.

Conclusion: pyomyoma is rare and may be difficult to be diagnosed clinically especially when there is a non-specific presentation as in this patient. Prompt clinical suspicion, broad spectrum antibiotics use and surgical intervention can be life-saving.