Difficult Drainage of Pyometra Post-chemoradiation of Cancer Cervix – A Case Report

Abstract Pyometra, or pyometrium, is defined as the accumulation of pus in the uterine cavity due to an interference with drainage and occurs in 0.1%–0.2% of all gynecological patients and 12.6% of elderly gynecological patients. Pyometrium is uncommon but is usually associated with advanced endometrial or cervical cancer. Pyometrium typically presents in postpartum or postmenopausal women with malodorous purulent vaginal discharge, bleeding, and pelvic pain but can also be asymptomatic. Manifestation of pyometrium is thought to be caused by the accumulation of pus in the uterine cavity resulting from bacteria ascending through the cervical canal with interference with its natural secretion drainage due to cervical stenosis. It is imperative that in postmenopausal women diagnosed with pyometra, gynecological malignancy could be considered as an underlying cause until proven otherwise. We are reporting a case of 66 year old lady with cervical cancer stage IIB who had undergone chemoradiation therapy for cervical cancer , developed pyometra with failed attempt of pyometra drainage. The patient underwent ultrasonography-guided plus laparoscopic-guided pyometra drainage. On culture, pus sample showed no organism growth. Postprocedure, the patient was managed conservatively and referred back to the cancer institute for further management.