Pyometra-An Atypical Complication Following LeFort Colpocleisis: Narrative Review

LeFort colpocleisis is a surgical alternative for women with pelvic organ prolapse (POP). Complications are rare and typically minor. The accumulation of purulence within the uterine cavity, or pyometra, after this procedure is exceptionally uncommon. To date, only a handful of cases have been reported. Hereby, we present a narrative review on the current knowledge regarding the diagnosis and treatment of this atypical complication.

A literature search was conducted using five different databases to identify previously published articles on this subject. Relevant keywords included colpocleisis, LeFort colpocleisis, pyometra, and reoperation. Studies describing complications after colpocleisis with concurrent hysterectomy or colpocleisis of vaginal vault were excluded.

Six case reports were identified, all from English-language sources. Data form an additional case at our institution was included. Median age was 78 years, and most women had multiple comorbidities. All underwent LeFort colpocleisis, with varying additional procedures. Only one case had a successful conservative approach; hysterectomy via laparotomy was ultimately required in the remaining cases. No cases of underlying malignancy were reported.

Pyometra is a rare but important differential diagnosis in patients with a history of LeFort colpocleisis presenting with fever, vaginal discharge, and abdominopelvic pain. A high index of clinical suspicion is paramount, since prompt diagnosis and appropriate surgical management are a standard of care.