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Abstract: Pus accumulation in the uterine cavity is caused by various factors leading to inflammation in the uterine cavity, or stimulation by non-inflammatory factors leading to obstruction of fluid drainage in the uterine cavity, which finally leads to fluid retention in the uterine cavity for a long time and causes pus accumulation. The main clinical manifestations are lower abdominal cramps, lumbago, abnormal leucorrhea, and vulvar odor. In this case, the patient had lower abdominal pain for more than 1 year after 20 years of menopause, and was diagnosed with accumulation of pus in the uterine cavity, and her symptoms were significantly relieved after uterine cavity irrigation and medication.
Basic information】Female, 69 years old
Disease Type】Uterine cavity abscess
Hospital】General Hospital of Heilongjiang Agricultural Reclamation Bureau
Date of consultation】May 2022
Treatment plan】Medication (mifepristone tablets pretreatment + metronidazole injection, saline irrigation of the uterine cavity + mebendazole injection, carboprost suppository to soften the cervix + metronidazole injection, piperacillin sodium tazobactam sodium for injection to fight infection)
Treatment period】7 days in hospital
Treatment effect] The patient complained of improvement of discomfort and no abdominal pain symptoms
I. Initial consultation
The patient came to our department for consultation. The aunt said slowly: I used to have occasional abdominal pain for about 1 year, but I did not pay attention to it and did not take any medicine. The gynecologist took a look at it. I said to my aunt: “Auntie, don’t worry, let’s do a checkup first to see if it’s a gynecological disease. Auntie was given a gynecological examination + ultrasound of the uterus and adnexa, combined vaginitis test, routine blood tests, etc. The result of the gynecological examination showed: uterine pressure pain (+). Combined vaginitis test: cleanliness: III degree, pH: 4.8, leukocyte esterase (+), hydrogen peroxide (+), the rest negative. Ultrasound examination of the uterus and adnexa suggested: uterine cavity effusion with multiple slightly hyperechoic areas in the uterine cavity, and the preliminary diagnosis was uterine cavity pus.
II. Treatment history
The patient was recommended to undergo outpatient hysteroscopy. The patient had been menopausal for 20 years, and the examination showed that the cervix was atrophied, making it impossible to enter the uterine cavity smoothly and making the operation difficult, so in order to smoothly dilate the cervix and drain the uterine fluid, oral mifepristone tablets were given for pretreatment. During the hysteroscopy, pus was seen in the uterine cavity, and the diagnosis of pus accumulation in the uterine cavity was clear. During the hysteroscopy, the patient was given a culture of secretion + drug sensitivity test, and the patient was given saline + metronidazole injection to rinse the uterine cavity, and the patient was referred to our department for further treatment. After admission to our department, the patient was given anti-infective treatment with metronidazole injection + piperacillin sodium tazobactam sodium for injection. 5 days later, the drug sensitivity result reported that Klebsiella pneumoniae, cephalosporin antibiotics are sensitive, so the patient continued to be treated with piperacillin sodium tazobactam sodium for injection, and the patient was admitted to our department for anti-infective treatment for 7 days.
III. Treatment effect
The patient was discharged after 7 days of antibiotic treatment in our department, with obvious improvement of symptoms and no abdominal pain, and the patient complained that the lower abdomen was much easier. The patient was instructed to continue the medication for consolidation.
IV. Notes
We are sincerely glad that the patient’s condition has improved. However, patients should observe whether they have symptoms of discomfort after discharge, and come to the hospital for follow-up in case of symptoms such as abdominal pain and discomfort. And do not stop the medication at will after discharge, but follow the doctor’s advice to take the medication regularly. In addition, they should pay attention to a balanced diet, strengthen nutrition, eat more high-protein and high-vitamin food, pay attention to rest, combine work and rest, and enhance the ability to resist diseases.
V. Personal insights
1, 20 years of menopause elderly women, their own basic diseases, for such elderly people found symptoms of lower abdominal pain, physical examination process found positive signs of uterine pressure, to highly suspect whether the uterine cavity pus, this paper patients after menopause gradually atrophy of the cervix, the residual fluid or blood in the uterine cavity must be difficult to drain, should be given great attention.
2, for elderly patients with cavity pus accumulation, a comprehensive assessment is needed in the course of doing any treatment. Due to severe atrophy of the cervix for many years after menopause, adequate cervical pretreatment needs to be given for patients with fluid or pus accumulation in the uterine cavity, which can be well resolved.
3. The accumulation of pus in the uterine cavity is not terrible, but timely treatment is needed to reduce the occurrence of other infections, especially for those who have their own underlying diseases should be given more attention.