Diagnostic features of pyomyoma of the uterus in combination with appendicitis (clinical case)

Abstract

The problem of leiomyoma of the uterus is one of the most urgent in gynecological practice due to the wide prevalence of the pathological condition and the possible complex of complications that lead to disability and even death of a woman. A rare complication of leiomyoma, which occurs as a result of its infarction and infection, is pyomyoma, the mortality of which is 21-30%, which is associated with the lack of early diagnosis and, accordingly, timely treatment in full. At the same time, the diagnosis of pyomyoma is difficult due to the lack of pathognomonic symptoms and a fixed clinical picture. The study presents a rare case of complication of a long-standing uterine leiomyoma with the development of pyomyoma and the occurrence of secondary appendicitis with the formation of a utero-appendicular fistula in a menopausal woman. The woman's complaints arose unexpectedly and were characterized by the presence of a pain syndrome, pathological discharge from the vagina, and deterioration of the general condition, which did not have a pathognomonic character. The presence of concomitant pathology was established, in particular, diabetes, which the patient suffered from since childhood and which could cause various pathological conditions of the reproductive system. The authors proved that in the presence of laboratory and general clinical signs of the inflammatory process, there is no need to waste time, but to start antibacterial and anti-inflammatory therapy even before the diagnosis is made, this allows stabilize the patient's condition and prepare for possible invasive interventions. The complexity of diagnosing the disease is shown and the main criteria for making a correct diagnosis are given, taking into account the woman's age, medical history, and the presence of severe extragenital pathology. The work shows that the use of computer tomography did not allow for establishing a diagnosis. It is emphasized that in complex or rarely occurring cases, it is not enough to conduct only non-invasive studies. Invasive techniques are gaining importance, in particular, laparoscopy, which allows detail of the state of internal genital organs and extragenital organs that surround them and can change during the disease. Keywords: ultrasound diagnostics, purulent tumor of the uterus, laparoscopy.