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首页> 外文期刊>Case Reports in Obstetrics and Gynecology >Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature
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Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature

机译：Nulligravid女性自发性破裂性脓性肌瘤：病例报告和文献复习。

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Introduction. Pyomyoma, or suppurative leiomyoma, is a rare complication of uterine fibroids. It occurs most commonly in the setting of pregnancy, the immediate postpartum period, or postmenopausal status. It may also arise after recent uterine instrumentation, after uterine artery embolization, or in immunocompromised patients. The most likely cause of pyomyoma is vascular compromise followed by bacterial seeding from direct, hematogenous, or lymphatic spread. Diagnosis is difficult, as the condition is rare, presents with vague symptoms, and is difficult to identify on imaging. Definitive diagnosis is only possible with surgery. Pathology shows a degenerating fibroid with hemorrhage, necrosis, cystic degeneration, and/or inflammatory change. Cultures of the pus contained within often show polymicrobial infection. Case Presentation. Our patient is a 24-year-old nulligravid female who presented with a surgical abdomen, fever, hypotension, and leukocytosis. She had no significant prior medical or surgical history, no history of uterine instrumentation, and no history of pelvic infection; she was not currently sexually active at the time of presentation. She was taken to the operating room, where she underwent diagnostic laparoscopy. This showed a ruptured pyomyoma originating in the left broad ligament. She then underwent laparoscopic myomectomy. She was transferred to the ICU intubated; she slowly recovered on IV antibiotics and was discharged home on postoperative day 10. Discussion. Pyomyoma is a rare condition and is even rarer in premenopausal patients without recent history of pregnancy or uterine instrumentation. This demonstrates an unusual case of spontaneous pyomyoma in the absence of risk factors, other than a history of known fibroids. Pyomyoma should be considered as a diagnosis in patients with sepsis, history of fibroids, and no other identifiable source of infection.
机译：介绍。脓肌瘤或化脓性平滑肌瘤是子宫肌瘤的一种罕见并发症。它最常见于怀孕，产后即刻或绝经后。它也可能在最近的子宫器械检查，子宫动脉栓塞术后或免疫功能低下的患者中出现。脓性肌瘤最可能的原因是血管受损，其次是直接，血源性或淋巴传播的细菌播种。诊断很困难，因为这种情况很少见，表现出模糊的症状，并且难以在影像学上鉴定。明确的诊断仅可通过手术进行。病理显示变性的肌瘤伴有出血，坏死，囊性变性和/或炎症变化。内含脓液的培养物通常显示出多菌感染。案例介绍。我们的患者是一位24岁的零重力女性，患有腹部外科手术，发烧，低血压和白细胞增多症。她没有明显的既往医学或外科手术史，没有子宫器械史，也没有骨盆感染史。在演示时，她目前还没有性活跃。她被带到手术室，在那里接受了诊断性腹腔镜检查。这表明脓肿性肌瘤起源于左阔韧带。然后，她接受了腹腔镜子宫肌瘤切除术。她被转移到插管的重症监护病房。她使用静脉注射抗生素慢慢康复，并在术后第10天出院回家。讨论。脓性肌瘤是一种罕见病，在绝经前患者中没有最近的妊娠或子宫检查史，这种病甚至更罕见。这表明除了已知的肌瘤病史以外，在没有危险因素的情况下发生自发性脓毒症的罕见情况。脓毒症，肌瘤病史以及没有其他可确定的感染源的患者应考虑脓毒症的诊断。

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