Spontaneous uterine perforation of pyometra. A report of three cases.

BACKGROUND: Spontaneous perforation of pyometra is a rare cause of generalized peritonitis; only 17 cases have been reported. CASES: Three cases of spontaneous perforation of pyometra occurred; two were associated with carcinoma of the cervix. All were treated with exploratory laparotomy and drainage. The first patient died of recurrent carcinoma of the cervix five months after laparotomy. The second patient died of septic shock shortly after the operation. The third patient made a good postoperative recovery. CONCLUSION: Pyometra is a serious medical condition, because of both its association with malignant disease and the danger of spontaneous perforation, which carries significant morbidity and mortality. Although rare, ruptured pyometra should be considered in the differential diagnosis of acute abdomen in elderly women, especially those with malignant disorders of the genital tract. The treatment of pyometra rupture is immediate laparotomy, peritoneal lavage and drainage, or simple hysterectomy.

Outpatient diagnostic hysteroscopy: analysis of 429 cases.

OBJECTIVE: To evaluate the diagnostic accuracy of outpatient hysteroscopy. METHODS: Outpatient CO2 hysteroscopy using video-camera for monitoring was performed on 429 patients from November 1995 to December 1996. The indications included post-menopausal bleeding (32.2%), menorrhagia (25.4%), irregular bleeding (24.7%), intermenstrual spotting (10.2%) and others (7.5%). RESULTS: Hysteroscopy was successfully performed on 420 (97.9%) patients. Although no anaesthetics were used, only two (0.47%) patients complained of severe pain during the procedure. Twenty-one (4.9%) patients had poor view due to submucosal fibroid or bloody view. There were no operative complications. Normal uterine cavity was found in 36.8% and atrophic endometrium in 34.7% of patients. The pathologies included submucosal fibroid (10.7%), endometrial polyp (5.8%) and fibroid polyp (2.8%). Five (1.2%) out of 429 patients were confirmed histologically to have endometrial carcinoma. No malignant lesions were missed. A total of 372 (86.7%) patients had histological confirmation of hysteroscopic findings. In 57 (13.2%) patients, the histological results did not correlate with the hysteroscopic findings. CONCLUSIONS: Outpatient hysteroscopy and suction curettage is a safe, cost-effective and acceptable procedure.

Conservative management of patients with histological incomplete excision of cervical intraepithelial neoplasia after large loop excision of transformation zone.

OBJECTIVE: To evaluate conservative management of patients with histological incomplete excision of CIN after large loop excision of transformation zone (LLETZ). METHODS: Two hundred and seventeen patients with high grade CIN were treated with LLETZ from October 1, 1992 to December 31, 1994. Fifty-three patients (24.4%) had incomplete excision on histology. All patients were followed up cytologically every 3 to 6 months during the first 18 months and then yearly till December 1996. Those patients with positive endocervical margins were followed up with both cervical smear and endocervical smear. RESULTS: The mean follow-up duration was 30.4 months. Ten patients were found to have persistent or recurrent disease. Five patients had second LLETZ and complete excision was achieved in 4 of them, one patient had cone biopsy and two had hysterectomy. One patient was found to have stage I a cervical cancer. CONCLUSION: A report of incomplete excision of CIN after LLETZ calls for follow-up with cytology and colposcopy and not aggressive retreatment.