Spontaneous Pyometra in a Very Elderly Woman Revealing Serous Endometrial Carcinoma: A Case Report

Pyometra is a rare accumulation of purulent material within the uterine cavity that most often arises in postmenopausal women with cervical stenosis. We report the case of an 86-year-old multiparous female patient with a history of multiple dilatation and curettage procedures who presented with a 15-day history of lower abdominal pain, spotting, and systemic signs of infection. Transvaginal ultrasound and contrast-enhanced CT confirmed a distended uterus filled with hypoechogenic fluid without evidence of perforation. Initial management with drainage under antibiotic coverage was complicated by paralytic ileus and rising inflammatory markers, prompting an emergency laparotomy. A total hysterectomy with bilateral salpingo-oophorectomy, appendectomy, and infracolic omentectomy was performed. Histopathology revealed a serous endometrial adenocarcinoma (International Federation of Gynecology and Obstetrics or FIGO stage IIC) confined to an endometrial polyp. Postoperatively, the patient recovered uneventfully, proceeded to adjuvant radiotherapy and brachytherapy because of occult malignancy, and remained disease-free at six months of follow-up. This case underscores the importance of early recognition and definitive surgical management of pyometra in elderly patients, as well as careful histopathologic evaluation to exclude underlying malignancy.