A Case of Uterine Rupture Secondary to Pyomyoma after an Uncomplicated Vaginal Delivery

A 31-year-old woman presented with a right lower quadrant abdominal pain. 

She had had an uncomplicated vaginal delivery a week prior. 

An ultrasound revealed fluid collection in her abdomen, prompting further evaluation in the emergency room. Computed tomography (CT) showed significant fluid-filled collections, raising concerns of phlegmons or early abscesses. 

The patient was hospitalized and started on intravenous (IV) antibiotics, and a drain was placed under CT guidance, draining purulent fluid. Blood cultures and fluid cultures were later identified as Fusobacterium nucleatum. Thereafter, the antibiotics were altered accordingly (changed to piperacillin and tazobactam).

Despite an initial improvement, repeat CT imaging revealed a persistent, large fluid collection. Surgical exploration was advised due to suspicion of uterine rupture. During laparotomy, extensive adhesions and small bowel serosal tears were found, leading to bowel resection. Further exploration identified a uterine defect in the left anterior fundus, indicative of spontaneous uterine rupture. The uterine defect was closed, and drains were placed. The patient recovered well and was discharged on postoperative day 5.

Diagnosis – pathology confirmed fibroid infarction, leading to pyomyoma, spontaneous uterine rupture, and intra-abdominal abscesses. 

Although rare, pyomyomas require a high index of suspicion for correct diagnosis. Signs of sepsis and pelvic pain in the presence of a fibroid uterus should raise suspicion. Ultrasound and CT scan aid diagnosis, but surgery is crucial for confirmation. Conservative management may be considered for fertility preservation, as demonstrated in this case.

Source: Hartman R, Colón-Mercado O, Johnson V, Baron J, Davis L. Case Reports in Obstetrics and Gynecology. 2023 Oct 4;2023.