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| CASE REPORT |
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| Year : 2014 | Volume
: 28
| Issue : 1 | Page : 52-53 |
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Pyocolpos with infected right ovarian cyst: A rare case report
Wanroi Dkhar, L Trinity Meetei, Sangey Pelzang, N Nabakishore Singh
Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| Date of Web Publication | 24-Jun-2014 |
Correspondence Address:
Dr. Wanroi Dkhar
Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-4958.135237
Pyocolpos is a rare clinical finding in vaginal atresia. Pyocolpos is cystic dilatation of the vagina due to accumulation of pus due to genital tract obstruction. The causes of obstruction can be imperforate hymen, transverse vaginal membrane, and rarely vaginal atresia. We present a case of 18-year-old married women Go Po+o, admitted with severe pain and swelling of the lower abdomen for 3 months. She had undergone laparotomy with vaginoplasty for vaginal atresia with hematocolpos and pyoperitoneum in 2009 and had refused mould insertion. On laparotomy, she was found to have pyocolpos and infected right ovarian cyst, which was probably due to re-obstruction of vagina. Right ovarian cystectomy followed by subtotal hysterectomy was performed. Post-operative period was uneventful. Following vaginoplasty, follow up and regular vaginal dilatation are essential to avoid complications involving re-obstruction and ascending genital infection. Keywords: Hematocolpos, Pyocolpos, Vaginal atresia, Vaginoplasty
How to cite this article:
Dkhar W, Meetei L T, Pelzang S, Singh N N. Pyocolpos with infected right ovarian cyst: A rare case report. J Med Soc 2014;28:52-3 |
| Introduction | |  |
Vaginal obstruction may result from a high vaginal septum, varying degrees of vaginal atresia, cloacal malformations, or an imperforate hymen. It may manifest at birth as a palpable mass or it may present at puberty as progressive accumulation of menstrual blood, causing hematometrocolpos.
Pyocolpos is a rare clinical finding in vaginal atresia. Pyocolpos is a cystic dilatation of the vagina due to the accumulation of pus resulting from the genital tract obstruction. The main cause of obstruction is imperforate hymen, transverse vaginal membrane, or vaginal atresia. In this case report, we present a woman with pyocolpos with infected right ovarian cyst.
| Case Report | | |
An 18-year-old married woman, G0 P0+0, was admitted with severe lower abdominal pain and mass per abdomen for 3 months. Abdominal examination revealed a 12 × 8 cm midline mass, tender, soft consistency, margin not well-defined. On per vaginal examination, vaginal orifice admitted tip of finger with minimal blood stained, dirty discharge was present. Bilateral fornices found to be tender. She was diagnosed to be having vaginal atresia, hematocolpos, and pyoperitoneum on Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) 3 years (2009) back, for which vaginoplasty as shown in [Figure 1] and laparotomy was done in RIMS, following which she refused to allow mould insertion following vaginoplasty. USG showed hematometrocolpos with bilateral ovarian complex cyst and left-sided hydrosalpinx. Contrast-enhanced Computed Tomography (CECT) showed pneumohydrometra with complex right ovarian cyst. Laparotomy was planned along with plastic surgery team, and the patient was counseled regarding the possibility of infertility, and consent was taken for hysterectomy. On laparotomy, flimsy adhesion was seen between the pelvic mass and anterior abdominal wall. Heart shape mass 12 × 8 cm size seen, bowel was adherent over the pelvic mass, which was separated by blunt dissection. Right cystectomy was done for right ovarian complex cyst followed by subtotal hysterectomy. Aspiration of right ovarian cyst revealed pus as shown in [Figure 2]. Post-operative period was uneventful. Histopathology report of hysterectomy specimen showed marked inflammation of the endometrium, myometrium upto the serosal layer. Few endometrial glands are seen in proliferative phase with marked congestion and extravasation. Sections from the right ovary show cyst lined by inflammatory granulation tissue with features of chronic oophoritis.  | Figure 2: Aspiration of pus from right ovarian cyst with adjacent uterus
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| Discussion | | |
Vaginal atresia is seen in 1 in 5000 to 10000 live female birth. Often, the anomaly is undetected until adolescence, when primary amenorrhea or abdominal pain from an obstructed uterovaginal tract prompts a diagnostic evaluation and management. Pyocolpos may be defined as an accumulation of excess of secondary-infected cervical secretions in vaginal cavity due to congenital atresia. [1]
Pyocolpos, an infected fluid collection within the vagina, is a rare condition, [2] association with imperforate hymen has also been reported. [3]
In our patient, vaginal atresia initially led to hematocolpos, for which drainage and vaginoplasty was done. She had re-obstruction, which leads to pyocolpos and infected right ovarian cyst. Hysterectomy was done for her to prevent the risk of re-infection and as the chance of fertility is remote. Similar cases were reported by Yoshika et al.[4] and Rana et al.,[5] in which hysterectomy was done in adolescent girls with repeated re-obstruction of the vagina and cervix.
Rarity and variable presentation of congenital genital tract anomalies can lead to delayed diagnosis and erroneous management. A high index of suspicion and cross-sectional imaging can help in early diagnosis. A comprehensive management is imperative to preserve the reproductive potentials, as significant proportion of patients may experience sexual difficulties, menstrual irregularity, and infertility. [6]
| Conclusion | | |
Pyocolpos is a rare finding in childhood, usually presented as a mass in the lower abdomen. Pyocolpos may cause sterile dysuria, urinary tract infection, and vesicovaginal fistula in children. Rarity and variable presentation of genital tract anomalies leads to delay in diagnosis. A high index of suspicion and cross-sectional imaging can help in early diagnosis. Centralization of care to clinicians with special interest, watchful follow up, and use of assisted reproductive techniques may preserve reproductive potential in these patients.
| Acknowledgment | | |
It is my great privilege on my part to express my sincere gratitude to Dr N. Sanjib Singh for his valuable help. I would also like to thank to my teachers Prof. N. Nabakishore Singh and Dr L. Trinity Meetei for their encouragement.
| References | | |
| 1. | Badeli H, Mircharkhchian M, Pirooz A. Prolonged sterile dysuria as a first presentation of pyocolpos. Iran J Kidney Dis 2010; 4:82-4. 
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| 2. | Graivier L. Hydrocolpos. J Pediatr Surg 1969; 4:563-8.
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| 3. | Brevetti LS, Kimura K, Brevetti GR, Lawrence JP, Soper RT. Pyocolpos: Diagnosis and treatment. J Pediatr Surg 1997; 32:110-1.
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| 4. | Yoshika T, Tokubo T, Yamaguchi T, Kimura O, Kitawaki J. Laparoscopic hysterectomy for pyometra and pyocolpos caused by obstruction in the vagina of a 13-year-old girl with urogenital sinus anomaly. J Jpn Soc Endosc Gynecol Obstet 2010; 26:255-9.
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| 5. | Rana A, Gurung G, Begum SH, Adhikari S, Neupane BB. Hysterectomy for hematometra in a 15-year-old mentally handicapped girl with congenital cervicovaginal agenesis and concomitant ovarian adenoma. J Obstet Gynaecol Res 2008; 34:105-7.
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| 6. | Khalid E, Jalil S, Anwar T, Nausheen S. Congenital female lower genital tract abnormailities: Two years experience in a teritiary care hospital. Pak J Surg 2011; 27:44-9.
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[Figure 1], [Figure 2]
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