تقيح الرحم Pyometra

The word pyometra is derived from Latin pyo meaning pus and metra
meaning uterus. The pyometra is an abscessed, pus-filled infected
uterus. Toxins and bacteria leak across the uterine walls and into the
bloodstream causing life-threatening toxic effects. Without treatment
death is inevitable.







What Might Make a Veterinarian Suspect this Infection?

Classically, the patient is an older female dog. (Pyometra can occur in
cats but its not nearly as common.) Usually, she has finished a heat
cycle in the previousl 1 to 2 months. She has a poor appetite and may be
vomiting or drinking an excessive amount of water. In the more usual
open pyometra, the cervix is open and the purulent uterine contents is
able to drip out thus a smelly vaginal discharge is usually apparent.

There is also a form of pyometra called a closed pyometra, where the
cervix is closed. In these cases, there is no vaginal discharge and the
clinical presentation is more difficult to diagnose. These patients also
tend to be sicker than those with open pyometra due to retention of the
toxic uterine contents.

Lab work shows a pattern typical of widespread infection which is often
helpful in narrowing down the diagnosis. Radiographs may show a gigantic
distended uterus though sometimes this is not obvious and ultrasound is
needed to confirm the diagnosis.

How does this Infection Come About?

With each heat cycle, the uterine lining engorges in preparation for
pregnancy. Eventually, some tissue engorgement becomes excessive or
persistent (a condition called cystic endometrial hyperplasia). This
lush glandular tissue is ripe for infection (recall that while the
inside of the uterus is sterile, the vagina below is normally loaded
with bacteria.). Bacteria ascend from the vagina and the uterus becomes
infected and ultimately pus filled.

What is the the Usual Treatment?

The usual treatment for pyometra is surgical removal of the uterus and
ovaries. It is crucial that the infected uterine contents do not spill
and that no excess hemorrhage occurs. The surgery is challenging
especially if the patient is toxic. Antibiotics are given at the time of
surgery and may or may not be continued after the uterus is removed.
Pain relievers are often needed post-operatively. A few days of
hospitalization are typically needed after the surgery is performed.

It is especially important that the ovaries be removed to remove future
hormonal influence from any small stumps of uterus that might be left
behind. If any ovary is left, the patient will continue to experience
heat cycles and be vulnerable to recurrence.

While this surgery amounts to the same end result as routine spaying,
there is nothing routine about a pyometra spay. As noted, the surgery is
challenging and the patient is in a life-threatening situation. For
these reasons, the pyometra spay typically costs five to ten times as
much as a routine spay.

Pros: The infected uterus is resolved rapidly (in an hour or two of surgery). No possibility of disease recurrence.

Cons: Surgery must be performed on a patient that could be unstable.