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Abstract: Although menopausal women no longer have menstrual flow, the endometrium will still have a certain secretion function. And due to the decline of ovarian function, the level of estrogen and progesterone in the body decreases year by year, which may cause slight adhesions at the endocervical canal or cervical canal, resulting in the inability to discharge secretions from the uterine cavity and the formation of pus in the uterine cavity. In this case, the patient was diagnosed with postmenopausal lower abdominal pain with increased secretion, and was diagnosed with uterine cavity pus accumulation. After combined treatment with cervical drainage and medication, the abdominal pain was significantly relieved and she recovered well.
Basic information】Female, 62 years old
Type of disease】Uterine cavity abscess
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】May, 2020
Treatment plan】Surgical treatment (cervical drainage + diagnostic curettage) + medication (Ceftriaxone sodium for injection + metronidazole injection + compound aminobarbital injection + ceftazidime for injection + cefradine capsule)
[Treatment period] 15 days of inpatient treatment
Treatment effect] Abdominal pain was significantly reduced and recovery was good
I. Initial consultation
The patient came to the clinic because she had been menopausal for 10 years, had lower abdominal pain and increased vaginal discharge for 5 days, accompanied by fever and chills for one day, and had applied hot compresses to her lower abdomen at home and taken cefuroxime tablets orally without relief. Examination showed 38.6℃, P: 96 beats/min, R: 20 beats/min, blood pressure 120/78mmHg.
The patient was acutely ill with flushed face, depressed, no abnormal cardiopulmonary auscultation, flat abdomen but significant lower abdominal pressure pain. The gynecological examination showed purulent vaginal discharge, marked painful cervical lifting, enlarged uterus with marked softness and pressure pain, and marked pressure pain in the bilateral adnexal area. She had suffered from endometritis in the past, but her symptoms were relieved by anti-inflammatory treatment and she did not return to the clinic.
Vaginal ultrasound: uterus size 6.2cm×6cm×5.5cm, liquid dark area in the uterine cavity with strong light point echogenicity in the dark area, ultrasound suggests the possibility of pus accumulation in the uterine cavity. Blood count: 16.2×10^9/L, neutrophils: 7.8×10^9/L. Preliminary clinical diagnosis: uterine cavity abscess.
II. Treatment history
Since the patient’s general condition was relatively poor, she was admitted to hospital for treatment. After hospitalization, she completed laboratory tests and immediately entered the operating room for routine sterilization and cervical drainage after completing the tests, and saw pus slowly flowing out from the uterine cavity. Before the results were available, the clinical application of the combination of ceftriaxone sodium for injection and metronidazole injection was administered intravenously. After the operation, the patient’s abdominal pain was significantly relieved, but he still had fever, and was given compound aminobarbital injection to reduce fever. On the 3rd postoperative day, the body temperature gradually decreased to normal. Bacterial culture plus drug sensitivity result 3 days after surgery: Staphylococcus aureus. The treatment was changed to ceftazidime for injection plus metronidazole injection to continue anti-inflammatory treatment until 13 days postoperatively. At 13 days postoperatively, with no contraindications after examination, diagnostic scraping was done and a small amount of endometrial tissue was scraped and sent for pathological examination, and cefradin capsules were taken orally after surgery.
III. Treatment effect
After cervical drainage, the patient’s abdominal pain was significantly reduced, her condition was stable, her body temperature was normal, her breathing was normal, the abdominal pressure pain disappeared on physical examination on the 7th postoperative day, the vaginal discharge was normal on gynecological examination on the 10th postoperative day, there was no painful lifting of the cervix, the uterus was atrophied, and no abnormality was palpated in both adnexal areas. Discharge was granted after 15 days of hospitalization. The pathology report before discharge was endometritis.
IV. Precautions
After the patient was discharged from the hospital, it is recommended to strengthen the local care of vulva. Observe whether the vaginal discharge is odorous, yellowish in color or bloody. Observe whether there is pain in the lower abdomen. It is recommended to pay attention to proper rest, abstain from sexual intercourse and sitz bath within 1 month. Take a light diet, but nutrition should be balanced, no spicy and sour food, no alcohol. Once clinical symptoms such as lower abdominal pain or vaginal discharge odor appear, it is recommended to return to the hospital for examination as soon as possible.
V. Personal insight
Although menopausal women no longer have menstrual flow, the endometrium will still have certain secretion function, but due to the decline of ovarian function, the estrogen and progesterone level in the body decreases year by year. At this time, it is likely to cause slight adhesions in the endocervical canal or the cervical canal, resulting in the inability to discharge secretions in the uterine cavity, thus forming pus in the uterine cavity.
In this case, the patient was not reviewed in time due to the discomfort, so it is likely that this accumulation of pus in the uterine cavity was caused by endometritis. Therefore, elderly women should seek medical treatment for increased vaginal discharge and lower abdominal pain and have regular gynecological examinations.