Ultrasound-guided percutaneous drainage of pyometra in cervical cancer patients on radiotherapy

Abstract

Background: Pyometra is a gynecological emergency in cervical cancer patients receiving radiotherapy because it can be complicated by perforation, sepsis, and death. It can delay initiation and continuation of treatment. For certain select patients who may not be able to undergo drainage of the lesion under anesthesia via cervical dilatation and drainage, ultrasound-guided percutaneous drainage is a good alternative. We report the successes recorded in using an alternative route for pyometra drainage in cervical cancer patients on radiotherapy when the conventional examination under anesthesia and cervical drainage was not possible. Patients and Methods: Following institutional ethical approval, a prospective study was conducted from January 2014 to January 2016 on selected patients referred from the radio-oncology unit of Ahmadu Bello University Teaching Hospital, Zaria to the Gynecologic Oncology Unit with pyometra complicating advanced cervical cancer on radiotherapy. Initial attempts at cervical dilatation and drainage under anesthesia were unsuccessful necessitating this approach of percutaneous drainage under ultrasound guidance with mild sedation after obtaining informed consent. Results: Six patients were managed with a mean age of 58.5 years, who were diagnosed with advanced cervical cancers clinical stages 2B to 3A on radiotherapy. An average of 200 ml of pus was drained, and culture revealed mixed infections with predominant anaerobes strongly sensitive to metronidazole. There was recurrence in 1 case (16.7%) after 1 month of follow-up requiring a repeat procedure. Conclusion: The procedure is relatively cheap, safe, and effective in selected patients.