Saboohi Tariq

Pyomyoma outside of pregnancy—Case report and systematic review of the literature

Abstract 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.

Navigating Pyomyoma in Pregnancy and Postpartum: A Systematic Review

To assess the different presentations of pyomyoma in pregnant and postpartum populations, and review the treatment modalities. This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a comprehensive search of PubMed, Scopus, Google Scholar and Embase during the years 1945 to October 2024. Included case reports assessed the types of intervention (hysterectomy, myomectomy, or other forms of treatments) to treat Pyomyoma. All case studies confirming a diagnosis of pyomyoma on either operative and/or histological findings were eligible. A total of 123 studies were initially screened and after a full-text evaluation, 40 articles with a total of 43 cases were included in this systematic review. Pyrexia and abdominal pain were the most common presenting symptoms found in 79% and 77% of patients, respectively. The most common causative organism was E-Coli (23%). Hysterectomy was performed in a total of 13 (30%) patients, myomectomy in 24 (56%) patients and 6 (14%) patients were treated conservatively. Given the considerable morbidity associated with pyomyoma, the benefits of surgical treatment tend to outweigh the potential risks. However, since pregnant and postpartum women are a younger cohort and fertility is a concern, myomectomy is preferred to hysterectomy.