A rare case of intrauterine device and asymptomatic huge pyometra

CASE REPORT: The 78-year-old wowan presented with an abdominal mass noted for more than 30 years. She has 8 children and intrauterine device (IUD) was inserted after her last delivery. She had not ever changed or removed the IUD. Abdominal palpable mass and occasional lower abdominal pain were noted but she did not look for help. Image studies showed a huge uterus with fluid acumination about 200x110x100 mm in size. An IUD was found near the internal cervical os. Pelvic examination revealed smooth cervix with obstructed os. Under laparotomy, huge uterus with about 2400ml pustular content and an IUD inside were noted. Subtotal hysterectomy was done and the postoperative course was uneventful. Pus culture report as follow: Bacteroides fragilis and Viridans stregpococcus. CONCLUSION: Huge pyometra can be asymptomatic for many years, and IUDs with obstructed cervix is an important cause in cases of pyometra.