Background

Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. It rarely occurs in premenopausal patients, particularly adolescents.

Case

A 16-year-old girl with multiple comorbidities including severe intellectual disability, neurogenic bladder, and recurrent urinary tract infection presented with fever, abdominal pain, and vaginal discharge after prolonged treatment with depot medroxyprogesterone acetate. Ultrasound imaging showed an intrauterine fluid collection consistent with hematometra; however, hysteroscopic evaluation confirmed pyometra, which was evacuated using a suction curette. Despite postoperative antibiotic therapy, she re-presented with similar findings requiring additional hysteroscopic evaluation and evacuation. After a third evacuation, an intrauterine catheter was placed to aid in drainage. This was not tolerated by the patient, and she ultimately required total laparoscopic hysterectomy for definitive management, which was performed without incident.

Summary and Conclusion

Pyometra is a rare occurrence that typically presents after menopause; however, it should be considered in patients with poor genitourinary hygiene and medically induced endometrial atrophy. In severe cases, hysterectomy might be required for definitive management.

中文翻译：

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病例报告：青少年反复发作。

背景

脓疱病是一种罕见且严重的疾病，通常在绝经后妇女中被诊断出。它很少发生在绝经前的患者中，尤其是青少年。

案件

一名16岁的女孩患有多种合并症，包括严重的智力障碍，神经源性膀胱和尿路反复感染，经长期使用醋酸甲羟孕酮治疗后出现发烧，腹痛和白带。超声检查显示宫腔积液符合血细胞计数。然而，宫腔镜检查证实脓疱，可使用刮匙将其疏散。尽管进行了术后抗生素治疗，她仍表现出类似的发现，需要进一步的宫腔镜评估和撤离。第三次撤离后，放置子宫内导管以帮助引流。病人不能忍受这一点，她最终需要进行全腹腔镜子宫切除术以进行明确的治疗，而没有发生意外。

总结与结论

脓疱病是罕见的，通常在更年期后出现。但是，对于泌尿生殖系统卫生差且医学引起的子宫内膜萎缩的患者应考虑使用。在严重的情况下，可能需要行子宫切除术以进行明确的治疗。