Pyometra following Le Fort colpocleisis

The Le Fort colpocleisis is an obliterative procedure used in the treatment of pelvic prolapse in elderly women where prolonged reconstructive surgery or general anesthesia may be medically contraindicated. Advantages include the ability to perform this procedure quickly under regional anesthesia with a low postoperative complication rate. The authors describe a previously unreported complication of partial colpocleisis requiring subsequent hysterectomy. A 92-year-old woman presented with a 10-day history of lower extremity edema and pelvic pain. She had recently undergone a second partial colpocleisis for recurrent pelvic prolapse in which the drainage channels were partially obliterated. Radiologic evaluation revealed an enlarged complex pelvic mass. At the time of laparotomy, an enlarged uterus filled with purulent material was noted which necessitated subsequent hysterectomy. It was concluded that, although uncommon, postoperative infection is a recognized complication of Le Fort colpocleisis. To minimize the chance of abscess, adequate lateral channels should be created and maintained during colpocleisis to allow drainage of postoperative secretions, bleeding and inflammatory exudate.