Copyright 2008
Definition
Endometritis is an inflammatory condition of the endometrium and can be acute or chronic. The most common cause is infection, staphylococcus aureus, streptococcus, and Gardnerella vaginalis. Acute infection is most commonly seen in post partum period, after a prolonged labor, following cesarian section, and premature rupture of membranes. The most common causes of chronic endometritis is PID, but may be caused by retained products of conception and IUD. Pyometrium is a form of chronic endometriti
Clinically the patienrt with acute endometritis presents with pain, fever, vaginal discharge and bleeding The patient with chronic endometritis presents with vague discomfort or chronic pain, sometimes with a blood stained discharge.
The clinical symptoms are characteristisc and ususally the diagnosis is made clinically particularly in the obstetric population where clinical suspicion is high. If the patient does not respond to antibiotics within 48-72 hours, then imaging to exclude an abscess, or retained products is warranted. Ultrasound is the procedure of choice, and it is able to identify abscesses and retained products but cannot confirm endometritis. If thrombophlebitis is considered then CT or MRI would be helpful.
Treatment is initially with antibiotics but if an abscess is identified it requires drainage, and if retained products are identified then dilatation and curettage is necessary.
Normal (above) and Endometritis (below) |
| The CTscan through the pelvis in the top image shows a heart shaped fluid filled endometrium with no enhancement of the mucosa/junctional zone and this patient was normal except for a focal probable physiologic process in the left adnexa and a small amount of free fluid in the right pararectal space. The second image is from a 20 year old female with severe colitis who demonstrates an enhancing endometrium that is suggestive of acute endomtritis. In addition she has a large amount of ascites allowing us to visualize both ovaries and broad ligaments.
46355 45318 hx 20 F with acute diarrhea and abdominal pain uterus endometrium fx fluid filled adnexa ovary ovaries normal fx ascites fx fluid in the rectum dx infectious colitis CTscan Courtesy Ashley Davidoff MD |
