Cervical cancer with pyometra—an insidious cause of uraemia in a post-menopausal woman

Case A 64-year-old post-menopausal woman presented with dysuria, weakness and poor appetite that had lasted 3 months. A bilateral percutaneous nephrostomy (PCN) catheter was placed for bilateral hydroureter- onephrosis at a local hospital, but malfunctioned due to blood clot formation. Physical examination revealed peritoneal signs. Laboratory test revealed leucocytosis, azotaemia with blood urea nitrogen (BUN) 93 mg/dl, creatimine (Cr) 16.3 mg/dl, and severe metabolic acidosis. Haemodialysis was initiated for uraemia. Computed tomography of the abdomen demonstrated the presence of ascites with peritoneal thickening in the lower peritoneal cavity, obstruction of the uterine outlet with intra-uterine fluid retention, tissue plane blurring between the uterine cervix and urinary bladder, and obstructive uropathy with the obstruction level at the bilateral uretero-vesical junction (Figures 1 and 2). Cervical cancer with pyometra was suspected and treated with dilation and curettage surgery, during which 150 c.c. of pus was drained out. Empiric antibiotics were given and sepsis resolved thereafter. A bilateral PCN catheter functioned well after repeated revisions. Haemodialysis was discontinued 3 weeks later (BUN 33 mg/dl, Cr 2.8 mg/dl). A biopsy of the cervix revealed squamous cell carcinoma with stromal invasion and the staging was IVA because of urinary bladder spreading. The patient recalled that she had suffered from intermittent vaginal spotting for the last 4 years, but had ignored it.