Myometrial Abscess: A Complication of Myomectomy of a Large Lower-Uterine Segment Myoma

Abstract

Abstract

Background: This article describes a patient with a history of two early miscarriages. She presented with menorrhagia and a recurrence of multiple fibroids. Laparotomy and myomectomy were performed and were complicated by a myometrial abscess. The diagnosis and management of such a rare complication are described. Case: A 39-year-old African American female (gravida 3, para 1) presented with a history of two early miscarriages, menorrhagia, and a recurrence of multiple fibroids. An ultrasound (US) scan revealed an enlarged uterus with at least six uterine fibroids. Laparotomy and myomectomy were performed. Four weeks later, this patient presented with complaints of pelvic pain, nausea, vomiting, constipation, and a fever of 1 day's duration. A US scan revealed a slightly enlarged uterus caused by a possible infected hematoma. The patient was admitted to the hospital and she was started on intravenous antibiotics after a blood culture was obtained. A computed tomography (CT) scan of her abdomen and pelvis confirmed the diagnosis of a myometrial abscess. This patient underwent CT scan–guided placement of a “pigtail” catheter in the myometrial abscess for continuous drainage. The result of the culture of the pus obtained from the abscess revealed the presence of multiple bacteria. The pigtail catheter was removed once there was no drainage 2 weeks after its initial insertion. Results: Two months after her discharge, a transvaginal US scan revealed that this patient's condition was essentially normal. Conclusions: This case report describes how a minimally invasive technique was used to manage a myometrial abscess, which is a complication of myomectomy. This report also illustrates the value of transvaginal US scanning for diagnosing such a pathology, and the roles US plays during management and follow-up. (J GYNECOL SURG 30:240)