Pyometra in Elderly Patients and Its Clinical Characteristics

In Ae Cho; MD; Ji Eun Park; MD; Jong Chul Baek; MD

doi:10.4235/jkgs.2016.20.1.42

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Ann Geriatr Med Res < Volume 20(1); 2016 < Articles

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

Pyometra in Elderly Patients and Its Clinical Characteristics

In Ae Cho, MD, Ji Eun Park, MD, Jong Chul Baek, MD

Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju, Korea

Correspondence to: Jong Chul Baek, MD
Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea
Tel: +82-55-750-8153, Fax: +82-55-750-1119 E-mail: gmfather@gmail.com

Received: September 9, 2015; Revised: January 11, 2016; Accepted: February 4, 2016; Published online: March 31, 2016.

Abstract: Background: Pyometra should be treated with caution in elderly patients because it may indicate a malignancy in the postmenopausal 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.; Keywords: Pyometra, Malignancy, Elderly, Peritonitis