産褥期の化膿性子宮筋腫に対して全腹腔鏡下子宮全摘術を施行し奏功した一例

抄録

　Pyomyoma is considered to occur following necrosis or ischemia of the fibroid, often during pregnancy, postpartum, or postmenopause. This report describes a case of successful treatment of pyomyoma in the postpartum period with total laparoscopic hysterectomy.

　The patient was a 39-year-old, G1P0 woman who had no significant medical history or medication use. She had a 10-cm intramural fibroid on the posterior wall of the uterus before pregnancy, which did not cause issues during her pregnancy, leading to a vaginal delivery at 39 weeks gestation. She was discharged on postpartum day 5 but readmitted on day 11 with lower abdominal pain and fever. She was diagnosed with pyomyoma based on localized pain, elevated inflammatory markers, and imaging findings. Antibiotic therapy was initiated, but fever and mild abdominal pain persisted. Due to a lack of improvement with conservative treatment and no desire for future pregnancies, she underwent total laparoscopic hysterectomy on day 14 of hospitalization, resulting in successful removal of an 800-g fibroid with signs of degeneration and purulent discharge.

　In this case, it is believed that the uterine fibroid underwent degeneration due to changes in blood circulation during the postpartum period, leading to an associated infection. There are reports of fibroid abscess rupture causing peritonitis and sepsis with disease progression. Therefore, surgical intervention is beneficial when conservative treatment with antibiotics is not effective. Laparoscopic surgery allows detailed observation of the pelvic area, and its small incisions contribute to reduced risks of infection and early mobilization.