Pyomyoma outside of pregnancy-Case report and systematic review of the literature.

BACKGROUND

Pyomyoma is a rare but potentially life-threatening phenomenon with a high mortality rate reaching up to 20%-30%. It can present in women during the antenatal or postpartum period as well as after uterine artery embolization or even spontaneously. Common presenting symptoms include abdomino-pelvic pain and fever in the presence of uterine leiomyoma.

OBJECTIVES

To assess the different presentations of pyomyoma in a non-pregnant population, and review the treatment modalities.

SEARCH STRATEGY: This systematic review was conducted following the PRISMA guidelines. We performed a comprehensive search of PubMed, Scopus, Google Scholar and Embase during the years 1945-2024.

SELECTION CRITERIA: Included case reports assessed the types of intervention (hysterectomy, myomectomy, or other forms of treatments) to treat pyomyoma. All case studies confirming diagnosis of pyomyoma on either operative and/or histologic findings were eligible.

DATA COLLECTION AND ANALYSIS: A total of 121 studies were initially screened and after a full text evaluation, 52 articles were included in this systematic review.

MAIN

RESULTS

Pyrexia and abdominal pain were the commonest presenting symptoms found in 72% and 57% of patients, respectively. The most common causative organism was E-coli (23%). A total of 61% of patients underwent hysterectomy, and 27% patients had a myomectomy performed. A total of 12% of patients were treated with conservative management.

CONCLUSIONS

Given the considerable mortality risk of approximately 20%-30%, the benefits of surgical treatment tend to outweigh the potential risks. Where future fertility is a concern, it may be possible to eliminate the source of infection by performing myomectomy instead of hysterectomy in conjunction with antimicrobials.