Conservative laparoscopic approach to a perforated pyomyoma after uterine artery embolization.
We describe a conservative laparoscopic approach to treatment of a perforated pyomyoma after uterine artery embolization. A 36-year-old woman came to our emergency department 8 weeks after undergoing uterine artery embolization. She reported painful abdominal cramps. Physical examination revealed fever, tachycardia, hypotension, abdominal pain with rebound tenderness and pain during bimanual examination. Ultrasonography showed a fundal/subserosal leiomyoma and a moderate amount of fluid in the abdominal cavity. Because the patient desired preservation of the uterus, a laparoscopic approach was used for drainage and lavage of a perforated pyomyoma. The patient had an uneventful recovery and remained well at follow-up visits. Second-look diagnostic laparoscopy enabled treatment of the adhesions formed and revealed patent fallopian tubes. Surgery has been the primary approach to pyomyoma. However, hysterectomy leads to irreversible sterility and myomectomy can be difficult to perform. Therefore, there is need for a less invasive intervention in women who seek conservative treatment. Recently, computed tomography-guided drainage was successfully performed in two patients with pyomyoma. To our knowledge, this is the first report of a successful conservative laparoscopic approach to pyomyoma.
Department of Gynecology, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal. evepinto@gmail.com
Evelin
E
Pinto
Artur
A
Trovão
Susana
S
Leitão
Carla
C
Pina
Foo kok
Fk
Mak
António
A
Lanhoso
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000628:therapy*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000382:microbiology / Q000628:therapy*; D059351:Organ Sparing Treatments; D011425:Propionibacterium acnes; D007507:Therapeutic Irrigation; D055357:Uterine Artery Embolization / Q000009:adverse effects; D014594:Uterine Neoplasms / Q000382:microbiology / Q000628:therapy*
D000900:Anti-Bacterial Agents