J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website https://www.jcgo.org

Review

Volume 11, Number 4, December 2022, pages 89-100

Pyometrium as an Early Indicator of Cervical Squamous Cell Carcinoma: A Systematic Review

Figure 1. Multiple detached fragments of squamous cell carcinoma in the curettage material (H&E, × 10). H&E: hematoxylin and eosin.

Figure 2. Fragments of glandular epithelium with numerous plasma cells in the curettage material (H&E, × 40). H&E: hematoxylin and eosin.

Figure 3. Residual minute microscopic focus of squamous cell carcinoma, hysterectomy material (H&E, × 10). H&E: hematoxylin and eosin.

Figure 4. Endometrium with severe acute, histiocytic and plasmocytic inflammation, hysterectomy material (H&E, × 40). H&E: hematoxylin and eosin.

**Table 1.** Characteristics of All Studies Included in the Systematic Review
Reference number	Author	Patient age	Workup	Treatment	Pathology	Complications	Outcome
CT: computed tomography; EMB: endometrial biopsy; D&C: dilation and curettage; US: ultrasound; MRI: magnetic resonance imaging; abd XR: abdominal X-ray; CXR: chest X-ray; abx: antibiotics; TAH: total abdominal hysterectomy; BSO: bilateral salpingo-oophorectomy; TVUS: transvaginal ultrasound; POD: post-operative; TV: transcervical; LEEP: loop electrosurgical excision procedure; CIN: cervical intraepithelial neoplasia; VAIN: vaginal intraepithelial neoplasia; TLH: total laparoscopic hysterectomy; IUD: intrauterine device; HPV: human papillomavirus type 16.
[5]	Zarour et al, 2021	68	CT, EMB, D&C	Total hysterectomy	No malignancy	Not ruptured	Lived
[7]	Saini et al, 2020 (case 1)	28	US, MRI	Staging laparotomy	Culture: Tuberculosis	Not ruptured	Lived
[7]	Saini et al, 2020 (case 2)	21	MRI pelvis	Staging laparotomy	Culture: Tubercle bacilli, dysgerminoma	Not ruptured	Lived
[8]	Walthall et al, 2021	80	CT abd/pelvis, US pelvis EMB, D&C	Abx	No malignancy	Not ruptured	Lived
[9]	Yildizhan et al, 2006	92	CXR, CT abd, laparotomy	TAH and BSO	No malignancy	Ruptured	Lived
[10]	Uno et al, 2016	90	CT, TVUS, laparotomy	TAH and BSO	No malignancy	Ruptured	Lived
[3]	Sirha et al, 2013	37	US, CT pelvis	TAH	No malignancy	Not ruptured	Lived
[11]	Tay et al, 2019	92	CT, TVUS	Abx, endometrial pipette drainage	X	Not ruptured	Lived
[12]	Huang et al, 2018	72	TVUS, CT, laparotomy	TAH and BSO, abx	No malignancy	Ruptured	Lived
[13]	Ikematsu et al, 1996	80	CT, laparotomy	TAH	No malignancy	Ruptured	Lived
[14]	Reis et al, 2016	27	Pelvic US	Abx, endometrial pipette drainage	X	Not ruptured	Lived
[4]	Yazawa et al, 2020 (case 1)	88	CT, laparotomy	TAH and BSO, resection sigmoid colon	No uterine malignancy, adenocarcinoma sigmoid colon	Ruptured	Died POD 189 d/t peritonitis and pneumonia
[4]	Yazawa et al, 2020 (case 2)	93	CT	Transcervical drainage, laparoscopic irrigation and drainage	X	Not ruptured	Lived
[15]	Sala et al, 2021	75	TVUS	D&C, abx	No malignancy	Not ruptured	Lived
[16]	Konishi et al, 2016	64	Colposcopic cervical biopsy, MRI, CT	Laparotomy, peritoneal lavage and drainage	Squamous cell carcinoma of the cervix	Ruptured	Lived
[17]	Chisthti et al, 2019	77	TVUS, MRI, chest CT	TAH and BSO, TV drainage, abx	Ziehl stain: acid fast bacilli, no malignancy	Not ruptured	Lived
[18]	Hagiya et al, 2015	80	CT	TV drainage, abx	Culture: E. coli	Not ruptured	Lived
[19]	Kutuk et al, 2013 (case 1)	71	CT abd, laparotomy	X	No malignancy	Ruptured	Lived
[19]	Kutuk et al, 2013 (case 2)	75	CT, laparotomy	TAH and BSO	No malignancy	Ruptured	Lived
[19]	Kutuk et al, 2013 (case 3)	68	CT abd/pelvis, TVUS, laparotomy	TAH and BSO	No malignancy	Ruptured	Died due to sepsis
[20]	Gul et al, 2019	35	TVUS, MRI	Needle evacuation	No malignancy	Not ruptured	Lived
[21]	Shapey et al 2012	84	CT, laparotomy	TAH	No malignancy	Ruptured	Lived
[22]	Gatongi et al, 2009	72	TVUS, hysteroscopy, EMB, Pipelle EMB	Abx	Culture: Mycobacterium tuberculosis	Not ruptured	Lived
[23]	Pankaja et al, 2014	74	MRI, hysteroscopy with drainage of pyometra and EMB	Abx	No malignancy	Not ruptured, diverticular mass with colouterine fistula	Lived
[24]	Kroon et al, 2016	65	CT, laparotomy	TAH	Squamous cell cervical carcinoma (prior to pyometra)	Ruptured	Lived
[25]	Gupta et al, 2012	50	CT abd	Drainage, abx	Culture: positive cocci in pairs and short chains	Not ruptured	Lived
[26]	Yahmadi et al, 2014	79	CT, laparotomy	TAH with BSO, abx	No malignancy	Not ruptured	Lived
[27]	Stunell et al, 2011	64	CT, laparotomy	TAH with BSO	No malignancy	Not ruptured	Lived
[28]	Kim et al, 2010	80	TVUS, CT, MRI, laparotomy	TAH with BSO, abx	No malignancy	Ruptured	Lived
[29]	Lodhi et al, 2011	32	TVUS, MRI, laparotomy	Subtotal hysterectomy	No malignancy	Not ruptured	Lived
[6]	Vyas et al, 2009	60	TVUS, CT	Pigtail drainage, abx	Previously diagnosed adenocarcinoma of the cervix	Ruptured	Lived
[30]	Shahid et al, 2006	80	TVUS, CT, laparotomy	TAH and BSO	Cervical carcinoma with secondary pyometra	Ruptured	Lived
[31]	Chan et al, 2006	64	CT, TVUS	Transrectal aspiration, LEEP	Squamous epithelial fragments with severe dysplasia CIN III and VAIN III	Not ruptured	Lived
[32]	Yang et al, 2006	64	CT abd	D&C, cervical biopsy, abx	Squamous cell carcinoma with stromal invasion and staging IVa	X	X
[33]	Chen et al, 2011	68	US abd, X-ray abd, laparotomy	TAH and BSO	No uterine malignancy, adenocarcinoma of the colon	Ruptured	Lived
[34]	Cheung et al, 2011	102	CT, Pap smear, cervical Bx	Radiation therapy	Stage 1B cervical cancer, pyometra after radiation treatments	Not ruptured	Died
[35]	Hofmann et al 2003	29	US abd	Abx, EMB, aspiration	No malignancy	Not ruptured	Lived
[36]	Lee et al, 2007	60	CXR, laparotomy	TAH with BSO, abx	Pyometra with poorly differentiated cervical squamous cell carcinoma	Ruptured	Lived
[37]	Zidi et al, 2003	75	Pelvic US	TAH with BSO	No malignancy	Not ruptured	Lived
[38]	Chan et al, 2005	84	TVUS	Hysteroscopy, uterine curettage, abx	Granulomatous inflammation, Ziehl-Nelson: acid fast bacilli	Not ruptured	Lived
[17]	Chishti et al, 2019	77	MRI pelvis, TVUS, CT chest	TLH with BSO, abx	Ziehl-Nelson stain: acid fast bacilli, no malignancy	Not ruptured	Lived
[39]	Razquin et al, 1993	52	Cervical biopsy	TLH with BSO	Squamous cell carcinoma in situ of the cervix associated with squamous cell carcinoma in situ of the endometrium	X	X
[40]	Kaneko et al, 1994	56	Laparotomy	TLH with BSO	No malignancy	Ruptured	Lived
[41]	Iwase et al, 2001 (case 1)	69	Pelvic US, CT, laparotomy	TAH	Culture: anaerobes, no malignancy	Not ruptured	Died due to organ failure
[41]	Iwase et al, 2001 (case 2)	89	CT, laparotomy	TLH with BSO	Culture: E. coli, no malignancy	Ruptured	Died due to acute coronary syndrome
[42]	Amin-Hanjani et al, 1995	47	X	Intrauterine drain, abx	No malignancy	Not ruptured	Lived
[44]	Dharmadhikari et al, 2007	44	Abd US, abd XR, laparotomy	TLH with right salpingo-oophorectomy and left salpingectomy with omentectomy, abx	No malignancy	Not ruptured	Lived
[44]	Kim et al, 2008	38	X	Hysterectomy, IUD removal, abx, patient declined hysterectomy	Cervical cancer	X	Died due to cervical cancer progression
[45]	Tai et al, 2007	79	Abd XR, abd US, CT abd	IUD removal, D&C, abx	Cultures: pseudomonas aeruginosa	Not ruptured	Lived
[46]	Sam et al, 1999	60	TVUS	Endometrial curetting, D&C, antibiotic therapy	Two fetal bone fragments found in endometrial cavity, culture: E. coli, no malignancy	X	X
[47]	Urushidani et al, 2020	73	US abd, CT abd	Drainage via vagina	Culture: Fusobacterium nucleatum, no malignancy	Not ruptured	Lived
[48]	Larkin et al, 2010	81	CT abd, laparotomy	Hartmann’s procedure	X	Not ruptured	Lived
[49]	Emergui Zrihen et al, 2017	69	TVUS, laparotomy	Peritoneal lavage, Abx	No malignancy	Ruptured	Lived
[50]	Noack et al, 2006	69	US, CT pelvis	Cervical dilation and drainage	No malignancy, culture: Enterococcus and P. magnus	Not ruptured	Died due to peritonitis with signs of systemic inflammation
[51]	Nikkhah-Abyaneh et al, 2010	43	CT abd, MRI pelvis, laparoscopy and hysteroscopy	TLH, abx	Culture: vancomycin-resistant enterococci, no malignancy	Not ruptured	Lived
[52]	Dogan-Ekici et al, 2007	67	TVUS	EMB, TAH with BSO	No malignancy	Not ruptured	X
[53]	Hurst et al, 2013	60	CT abd	D&C, abx	Invasive squamous cell carcinoma	X	X
[54]	Shukla et al, 2012	65	CT abd	TAH and BSO	Culture: Enterococcus faecalis, no malignancy	X	X
[55]	Yasa et al, 2015	72	CT abd	Transabdominal drainage, TAH with BSO, upper vaginectomy, abx	Culture: Escherichia coli	Not ruptured	Lived
[56]	Nakao et al, 2000	86	Abd XR, US, CT, laparotomy	Supravaginal hysterectomy	Culture: Clostridium sphenoides, no malignancy	Ruptured	Lived
[57]	Orum et al, 2017	64	TVUS, CT abd	Abx, transvaginal drainage	Culture: T. praeacuta and C. hastiforme, no malignancy	Not ruptured	Lived
[58]	Inui et al, 1999	88	CXR, laparoscopy	TLH with BSO	Cultures: E. coli, no malignancy	Ruptured	Lived
[59]	Choudhary et al, 2014	65	CXR, laparotomy	X	X	Ruptured	X
[60]	Chuang et al, 2012	78	CT abd, US abd, laparotomy	TAH	Culture: Bacteroides fragilis and Streptococcus viridans	Not ruptured	Lived
[61]	Izumi et al, 2010	83	CT abd	TAH, drainage	Culture: Bacteroides distasonis, Porphyromonas asaccharolytica, and Streptococcus oralis, no malignancy	Ruptured, postoperative pneumonia and subsequent respiratory insufficiency	Lived
[62]	Yin et al, 2016	67	CT abd, laparotomy	TAH with BSO, drainage	Culture: Staphylococcus epidermidis, no malignancy	Ruptured, wound dehiscence	Lived
[63]	Shayya et al, 2009	78	CT abd, US abd	Transabdominal drainage, manual dilation of lateral vaginal tracts via 24-F catheters, abx	Culture: Morganella morganii, no malignancy	Not ruptured	Lived
[64]	Ploteau et al, 2012 (case 1)	23	CT abd, laparotomy	Subtotal hysterectomy	Culture: Escherichia coli	Not ruptured	Lived
[64]	Ploteau et al, 2012 (case 2)	27	CT abd	Adhesion release, subtotal hysterectomy	X	Not ruptured	Lived
[65]	Saha et al, 2008	60	US abd, abd XR, laparotomy	Supravaginal hysterectomy with salpingo-ophorectomy and peritoneal lavage, abx	Culture: Staphylococcus aureus, no malignancy	Ruptured	Lived
[66]	Garanpayeh et al, 2006	63	US abd, CT abd, Laparotomy	TLH with BSO, abx	No malignancy	Ruptured	Lived
[67]	Bagga et al, 2008	60	Speculum and vaginal examinations, US abd	TAH	Primary squamous cell carcinoma of endometrium	X	X
[68]	Chao et al, 2013	60	US abd, TVUS, CT abd, CT chest, laparotomy	Uterine drainage, subtotal hysterectomy with BSO, abx	Culture: S. epidermidis, squamous cell carcinoma in situ, HPV 16+	Not ruptured, bacteremia	Died due to septic shock and multiple organ failure caused by persistent bacteremia
[69]	Cho et al, 2011	74	Pelvic US, CT pelvis	Drainage of vaginal canal, external beam radiotherapy	Stage 3 squamous cell carcinoma in the vagina	X	X
[70]	Kriplani et al, 1994	59	Speculum and vaginal examinations, US abd	Lippes loop removed, D&C, abx	Culture: Actinomyces israelii, no malignancy	Not ruptured	Lived
[71]	Kimura et al, 1994	72	Abd XR, laparotomy	TLH with BSO	No malignancy	Ruptured, subcutaneous abscess and pneumonia	Lived
[72]	Chaopotong et al, 2012	88	TVUS, laparotomy	TLH with BSO	No malignancy	Ruptured	Died due to severe sepsis and multiple organ failure
[73]	Roth et al, 2007	78	Pelvic US, CT abd, laparotomy	TAH with BSO and upper vaginectomy	No malignancy	Not ruptured	Lived
[74]	Deutchman et al, 2013	29	Abd US	Pipelle catheter aspiration, abx	Culture: group B strep	Not ruptured	Lived
[75]	Habek et al, 2005	84	Pelvic US, laparotomy	TLH with BSO, appendectomy, omentectomy, and drainage of the Douglas space	Culture: Escherichia coli, no malignancy	Not ruptured	Lived

Table 1. Characteristics of All Studies Included in the Systematic Review

Reference number

Author

Patient age

Workup

Treatment

Pathology

Complications

Outcome

CT: computed tomography; EMB: endometrial biopsy; D&C: dilation and curettage; US: ultrasound; MRI: magnetic resonance imaging; abd XR: abdominal X-ray; CXR: chest X-ray; abx: antibiotics; TAH: total abdominal hysterectomy; BSO: bilateral salpingo-oophorectomy; TVUS: transvaginal ultrasound; POD: post-operative; TV: transcervical; LEEP: loop electrosurgical excision procedure; CIN: cervical intraepithelial neoplasia; VAIN: vaginal intraepithelial neoplasia; TLH: total laparoscopic hysterectomy; IUD: intrauterine device; HPV: human papillomavirus type 16.

[5]

Zarour et al, 2021

CT, EMB, D&C

Total hysterectomy

No malignancy

Not ruptured

Lived

[7]

Saini et al, 2020 (case 1)

US, MRI

Staging laparotomy

Culture: Tuberculosis

Not ruptured

Lived

[7]

Saini et al, 2020 (case 2)

MRI pelvis

Staging laparotomy

Culture: Tubercle bacilli, dysgerminoma

Not ruptured

Lived

[8]

Walthall et al, 2021

CT abd/pelvis, US pelvis EMB, D&C

Abx

No malignancy

Not ruptured

Lived

[9]

Yildizhan et al, 2006

CXR, CT abd, laparotomy

TAH and BSO

No malignancy

Ruptured

Lived

[10]

Uno et al, 2016

CT, TVUS, laparotomy

TAH and BSO

No malignancy

Ruptured

Lived

[3]

Sirha et al, 2013

US, CT pelvis

TAH

No malignancy

Not ruptured

Lived

[11]

Tay et al, 2019

CT, TVUS

Abx, endometrial pipette drainage

Not ruptured

Lived

[12]

Huang et al, 2018

TVUS, CT, laparotomy

TAH and BSO, abx

No malignancy

Ruptured

Lived

[13]

Ikematsu et al, 1996

CT, laparotomy

TAH

No malignancy

Ruptured

Lived

[14]

Reis et al, 2016

Pelvic US

Abx, endometrial pipette drainage

Not ruptured

Lived

[4]

Yazawa et al, 2020 (case 1)

CT, laparotomy

TAH and BSO, resection sigmoid colon

No uterine malignancy, adenocarcinoma sigmoid colon

Ruptured

Died POD 189 d/t peritonitis and pneumonia

[4]

Yazawa et al, 2020 (case 2)

Transcervical drainage, laparoscopic irrigation and drainage

Not ruptured

Lived

[15]

Sala et al, 2021

TVUS

D&C, abx

No malignancy

Not ruptured

Lived

[16]

Konishi et al, 2016

Colposcopic cervical biopsy, MRI, CT

Laparotomy, peritoneal lavage and drainage

Squamous cell carcinoma of the cervix

Ruptured

Lived

[17]

Chisthti et al, 2019

TVUS, MRI, chest CT

TAH and BSO, TV drainage, abx

Ziehl stain: acid fast bacilli, no malignancy

Not ruptured

Lived

[18]

Hagiya et al, 2015

TV drainage, abx

Culture: E. coli

Not ruptured

Lived

[19]

Kutuk et al, 2013 (case 1)

CT abd, laparotomy

No malignancy

Ruptured

Lived

[19]

Kutuk et al, 2013 (case 2)

CT, laparotomy

TAH and BSO

No malignancy

Ruptured

Lived

[19]

Kutuk et al, 2013 (case 3)

CT abd/pelvis, TVUS, laparotomy

TAH and BSO

No malignancy

Ruptured

Died due to sepsis

[20]

Gul et al, 2019

TVUS, MRI

Needle evacuation

No malignancy

Not ruptured

Lived

[21]

Shapey et al 2012

CT, laparotomy

TAH

No malignancy

Ruptured

Lived

[22]

Gatongi et al, 2009

TVUS, hysteroscopy, EMB, Pipelle EMB

Abx

Culture: Mycobacterium tuberculosis

Not ruptured

Lived

[23]

Pankaja et al, 2014

MRI, hysteroscopy with drainage of pyometra and EMB

Abx

No malignancy

Not ruptured, diverticular mass with colouterine fistula

Lived

[24]

Kroon et al, 2016

CT, laparotomy

TAH

Squamous cell cervical carcinoma (prior to pyometra)

Ruptured

Lived

[25]

Gupta et al, 2012

CT abd

Drainage, abx

Culture: positive cocci in pairs and short chains

Not ruptured

Lived

[26]

Yahmadi et al, 2014

CT, laparotomy

TAH with BSO, abx

No malignancy

Not ruptured

Lived

[27]

Stunell et al, 2011

CT, laparotomy

TAH with BSO

No malignancy

Not ruptured

Lived

[28]

Kim et al, 2010

TVUS, CT, MRI, laparotomy

TAH with BSO, abx

No malignancy

Ruptured

Lived

[29]

Lodhi et al, 2011

TVUS, MRI, laparotomy

Subtotal hysterectomy

No malignancy

Not ruptured

Lived

[6]

Vyas et al, 2009

TVUS, CT

Pigtail drainage, abx

Previously diagnosed adenocarcinoma of the cervix

Ruptured

Lived

[30]

Shahid et al, 2006

TVUS, CT, laparotomy

TAH and BSO

Cervical carcinoma with secondary pyometra

Ruptured

Lived

[31]

Chan et al, 2006

CT, TVUS

Transrectal aspiration, LEEP

Squamous epithelial fragments with severe dysplasia CIN III and VAIN III

Not ruptured

Lived

[32]

Yang et al, 2006

CT abd

D&C, cervical biopsy, abx

Squamous cell carcinoma with stromal invasion and staging IVa

[33]

Chen et al, 2011

US abd, X-ray abd, laparotomy

TAH and BSO

No uterine malignancy, adenocarcinoma of the colon

Ruptured

Lived

[34]

Cheung et al, 2011

102

CT, Pap smear, cervical Bx

Radiation therapy

Stage 1B cervical cancer, pyometra after radiation treatments

Not ruptured

Died

[35]

Hofmann et al 2003

US abd

Abx, EMB, aspiration

No malignancy

Not ruptured

Lived

[36]

Lee et al, 2007

CXR, laparotomy

TAH with BSO, abx

Pyometra with poorly differentiated cervical squamous cell carcinoma

Ruptured

Lived

[37]

Zidi et al, 2003

Pelvic US

TAH with BSO

No malignancy

Not ruptured

Lived

[38]

Chan et al, 2005

TVUS

Hysteroscopy, uterine curettage, abx

Granulomatous inflammation, Ziehl-Nelson: acid fast bacilli

Not ruptured

Lived

[17]

Chishti et al, 2019

MRI pelvis, TVUS, CT chest

TLH with BSO, abx

Ziehl-Nelson stain: acid fast bacilli, no malignancy

Not ruptured

Lived

[39]

Razquin et al, 1993

Cervical biopsy

TLH with BSO

Squamous cell carcinoma in situ of the cervix associated with squamous cell carcinoma in situ of the endometrium

[40]

Kaneko et al, 1994

Laparotomy

TLH with BSO

No malignancy

Ruptured

Lived

[41]

Iwase et al, 2001 (case 1)

Pelvic US, CT, laparotomy

TAH

Culture: anaerobes, no malignancy

Not ruptured

Died due to organ failure

[41]

Iwase et al, 2001 (case 2)

CT, laparotomy

TLH with BSO

Culture: E. coli, no malignancy

Ruptured

Died due to acute coronary syndrome

[42]

Amin-Hanjani et al, 1995

Intrauterine drain, abx

No malignancy

Not ruptured

Lived

[44]

Dharmadhikari et al, 2007

Abd US, abd XR, laparotomy

TLH with right salpingo-oophorectomy and left salpingectomy with omentectomy, abx

No malignancy

Not ruptured

Lived

[44]

Kim et al, 2008

Hysterectomy, IUD removal, abx, patient declined hysterectomy

Cervical cancer

Died due to cervical cancer progression

[45]

Tai et al, 2007

Abd XR, abd US, CT abd

IUD removal, D&C, abx

Cultures: pseudomonas aeruginosa

Not ruptured

Lived

[46]

Sam et al, 1999

TVUS

Endometrial curetting, D&C, antibiotic therapy

Two fetal bone fragments found in endometrial cavity, culture: E. coli, no malignancy

[47]

Urushidani et al, 2020

US abd, CT abd

Drainage via vagina

Culture: Fusobacterium nucleatum, no malignancy

Not ruptured

Lived

[48]

Larkin et al, 2010

CT abd, laparotomy

Hartmann’s procedure

Not ruptured

Lived

[49]

Emergui Zrihen et al, 2017

TVUS, laparotomy

Peritoneal lavage, Abx

No malignancy

Ruptured

Lived

[50]

Noack et al, 2006

US, CT pelvis

Cervical dilation and drainage

No malignancy, culture: Enterococcus and P. magnus

Not ruptured

Died due to peritonitis with signs of systemic inflammation

[51]

Nikkhah-Abyaneh et al, 2010

CT abd, MRI pelvis, laparoscopy and hysteroscopy

TLH, abx

Culture: vancomycin-resistant enterococci, no malignancy

Not ruptured

Lived

[52]

Dogan-Ekici et al, 2007

TVUS

EMB, TAH with BSO

No malignancy

Not ruptured

[53]

Hurst et al, 2013

CT abd

D&C, abx

Invasive squamous cell carcinoma

[54]

Shukla et al, 2012

CT abd

TAH and BSO

Culture: Enterococcus faecalis, no malignancy

[55]

Yasa et al, 2015

CT abd

Transabdominal drainage, TAH with BSO, upper vaginectomy, abx

Culture: Escherichia coli

Not ruptured

Lived

[56]

Nakao et al, 2000

Abd XR, US, CT, laparotomy

Supravaginal hysterectomy

Culture: Clostridium sphenoides, no malignancy

Ruptured

Lived

[57]

Orum et al, 2017

TVUS, CT abd

Abx, transvaginal drainage

Culture: T. praeacuta and C. hastiforme, no malignancy

Not ruptured

Lived

[58]

Inui et al, 1999

CXR, laparoscopy

TLH with BSO

Cultures: E. coli, no malignancy

Ruptured

Lived

[59]

Choudhary et al, 2014

CXR, laparotomy

Ruptured

[60]

Chuang et al, 2012

CT abd, US abd, laparotomy

TAH

Culture: Bacteroides fragilis and Streptococcus viridans

Not ruptured

Lived

[61]

Izumi et al, 2010

CT abd

TAH, drainage

Culture: Bacteroides distasonis, Porphyromonas asaccharolytica, and Streptococcus oralis, no malignancy

Ruptured, postoperative pneumonia and subsequent respiratory insufficiency

Lived

[62]

Yin et al, 2016

CT abd, laparotomy

TAH with BSO, drainage

Culture: Staphylococcus epidermidis, no malignancy

Ruptured, wound dehiscence

Lived

[63]

Shayya et al, 2009

CT abd, US abd

Transabdominal drainage, manual dilation of lateral vaginal tracts via 24-F catheters, abx

Culture: Morganella morganii, no malignancy

Not ruptured

Lived

[64]

Ploteau et al, 2012 (case 1)

CT abd, laparotomy

Subtotal hysterectomy

Culture: Escherichia coli

Not ruptured

Lived

[64]

Ploteau et al, 2012 (case 2)

CT abd

Adhesion release, subtotal hysterectomy

Not ruptured

Lived

[65]

Saha et al, 2008

US abd, abd XR, laparotomy

Supravaginal hysterectomy with salpingo-ophorectomy and peritoneal lavage, abx

Culture: Staphylococcus aureus, no malignancy

Ruptured

Lived

[66]

Garanpayeh et al, 2006

US abd, CT abd, Laparotomy

TLH with BSO, abx

No malignancy

Ruptured

Lived

[67]

Bagga et al, 2008

Speculum and vaginal examinations, US abd

TAH

Primary squamous cell carcinoma of endometrium

[68]

Chao et al, 2013

US abd, TVUS, CT abd, CT chest, laparotomy

Uterine drainage, subtotal hysterectomy with BSO, abx

Culture: S. epidermidis, squamous cell carcinoma in situ, HPV 16+

Not ruptured, bacteremia

Died due to septic shock and multiple organ failure caused by persistent bacteremia

[69]

Cho et al, 2011

Pelvic US, CT pelvis

Drainage of vaginal canal, external beam radiotherapy

Stage 3 squamous cell carcinoma in the vagina

[70]

Kriplani et al, 1994

Speculum and vaginal examinations, US abd

Lippes loop removed, D&C, abx

Culture: Actinomyces israelii, no malignancy

Not ruptured

Lived

[71]

Kimura et al, 1994

Abd XR, laparotomy

TLH with BSO

No malignancy

Ruptured, subcutaneous abscess and pneumonia

Lived

[72]

Chaopotong et al, 2012

TVUS, laparotomy

TLH with BSO

No malignancy

Ruptured

Died due to severe sepsis and multiple organ failure

[73]

Roth et al, 2007

Pelvic US, CT abd, laparotomy

TAH with BSO and upper vaginectomy

No malignancy

Not ruptured

Lived

[74]

Deutchman et al, 2013

Abd US

Pipelle catheter aspiration, abx

Culture: group B strep

Not ruptured

Lived

[75]

Habek et al, 2005

Pelvic US, laparotomy

TLH with BSO, appendectomy, omentectomy, and drainage of the Douglas space

Culture: Escherichia coli, no malignancy

Not ruptured

Lived