Painless ruptured pyomyoma causing an abdominal abscess in a postmenopausal woman with abdominal hypoesthesia
Abstract
Pyomyoma is a rare condition caused by an infection within a uterine leiomyoma. When ruptured, it can cause peritonitis with continuous abdominal pain, potentially leading to life‐threatening conditions. However, abdominal pain may be absent in patients with abdominal hypoesthesia. We report a case of painless ruptured pyomyoma causing an abdominal abscess in a 60‐year‐old woman with abdominal hypoesthesia. The patient with a T4‐level sensory deficit due to an acute disseminated encephalomyelitis sequela presented with persistent fever but no abdominal pain. She was initially diagnosed with appendicitis and received antibiotics; however, the inflammatory response and fever persisted. Further investigations revealed a ruptured pyomyoma forming an intra‐abdominal abscess. Additional antibiotic administration and extensive surgeries, including hysterectomy, bilateral salpingo‐oophorectomy, and ileocecal excision, resolved the severe peritonitis. The postoperative course was uneventful without any relapse. Lack of abdominal pain related to abdominal hypoesthesia can mask the severity of peritonitis.
