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Abstract: The onset of acute endometritis is overwhelmingly associated with a history of uterine manipulation, such as curettage, induced negative pressure abortion, IUD removal, etc., all of which may lead to bacterial infection. In this case, the patient suddenly developed lower abdominal cramping with fever and headache. After drug treatment and diagnostic curettage, pathological examination suggested acute endometritis, and adequate antibiotic treatment was given. The patient’s clinical symptoms were relieved, and the subsequent oral medication was used to consolidate the treatment, and the patient’s discomfort disappeared at the time of review.
Basic information】Female, 29 years old
Type of disease】Acute endometritis
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】October 2021
Treatment plan】General treatment + medication (penicillin sodium for injection + metronidazole injection + ibuprofen slow-release tablets + gynecological Qianjin capsule) + surgical treatment (diagnostic scraping)
[Treatment cycle]: 14 days of hospitalization, review after 1 month
Treatment effect】No localized congestion and edema of the cervix, disappearance of symptoms
I. Initial consultation
In October 2021, the patient came to the clinic with abdominal pain for 3 days and fever for 3 days 7 days after IUD removal. 3 days after IUD removal, she had a history of sexual intercourse and then took a bath. 3 days before, she had lower abdominal pain with fever, increased leucorrhea with a bad odor, joint and muscle pain, headache, T39℃, P96 times/minute, R20 times/minute, Bp112/68mmHg, no abnormal heart and lung auscultation. No abnormality in cardiopulmonary auscultation, significant pressure pain on the pubic symphysis. Gynecological examination: normal vulvovaginal development, large amount of purulent vaginal discharge discharging from the cervix, local congestion and edema, obvious painful cervical lifting and posterior fornix tenderness, normal size and anterior position of the uterus, normal activity but obvious pressure pain, no abnormalities were palpated in the bilateral adnexal area. The blood count was 17.3×10＾9/L. Vaginal color ultrasonography: normal size of uterus, uniform myometrial echogenicity, swollen endometrium, obvious blood flow signal, and a little fluid in the uterine cavity; the initial consideration was acute endometritis, and pathological examination was needed to confirm the diagnosis.
II. Treatment history
1. General treatment: rest in a semi-recumbent position, with a light diet, but with a reasonable nutritional mix, such as eating more fresh fruits and vegetables with vitamins, and supplementing with protein. Strengthening local care of the vulva.
2, drug treatment: intravenous drip penicillin sodium (negative skin test) and metronidazole injection combined drug treatment. When the body temperature exceeds 38.5℃ on the same day, take oral ibuprofen extended-release tablets to lower the temperature. When the body temperature is higher than 37.5℃ and lower than 38.5℃, physical cooling methods are used clinically to bring down the body temperature gradually.
3, diagnostic scraping: through intravenous drip penicillin sodium and metronidazole injection for 9 days, the patient’s clinical symptoms completely disappeared, no pain in the lower abdomen, normal body temperature, not much vaginal discharge, no local congestion and edema of the cervix through gynecological examination, not much surface discharge, no painful lifting of the cervix, normal size of the uterus and no pressure pain. In the absence of positive signs, the patient was given diagnostic scraping under aseptic operation, and the scraped out endometrial tissue was sent to pathology for laboratory tests. Intravenous drip penicillin sodium and metronidazole injection therapy was continued after the scraping operation.
III. Treatment effect
After 14 days of intravenous penicillin sodium and metronidazole injection, the patient’s clinical symptoms were significantly relieved and reached the disappearance of symptoms. After gynecological examination, there was not much vaginal discharge, no local congestion and edema of the cervix, normal size of the uterus, normal activity, no pressure pain, and no abnormality in the bilateral adnexal area was palpated. On routine blood examination, the white blood cell count was 6.3×10＾9/L. On vaginal ultrasound, the uterus was normal in size, the endometrial thickness was 7 mm, the echogenicity was uniform, no abnormal echogenic mass was seen in the uterine cavity, and no tumor mass was seen in the pelvis.
IV. Precautions
After discharge, the patient should rest properly, eat a light diet, forbid to eat spicy and acidic food and drink alcohol, and take oral gynecological Qianjin capsule for 7-10 days, and should not have sexual intercourse or take a sitz bath within 1 month after surgery to avoid inflammatory reactions in the reproductive tract. I am glad that this patient has recovered by the time of review, but through this case, we suggest women to go for gynecological examination once a year to ensure our own health and to take good contraceptive measures in our daily life.
V. Personal insight
In this case, the patient did not have intercourse and take a bath too early after IUD removal, which led to acute endometritis and caused lower abdominal pain and fever. It is recommended that women who have had negative pressure abortion, IUD removal, or IUD removal surgery must strictly follow medical advice to avoid gynecological inflammation due to premature intercourse. In addition, bathing water is not sterile and premature bathing can also lead to retrograde infection caused by germs entering the vagina.